Anemia

Classification of anemia Hypoproliferative -Iron deficiency anemia -Vit. B12 deficiency anemia (megaloblastic) -Folate deficiency (megaloblastic) -Decreased erythropoietin production -Cancer/Inflammation

Hemolytic Anemia Sickle Cell Anemia Thalassemia Immune Hemolytic anemia Hereditary Hemochromatosis Polycythemia Leukopenia Leukemia Agnogenic Myeloid Metaplasia Lymphoma Multiple Myoloma

Bleeding Anemia Primary Thrombocythemia Secondary Thrombocythemia thrombocythemia Idiopathic Thrombocytopenic Purpura Platelet Defects

Hypoproliferative Anemia

Iron deficiency Anemia

is a condition where a person has inadequate amounts of iron to meet body demands. It is a decrease in the amount of red cells in the blood caused by having too little iron. Iron deficiency anemia is usually caused by a diet insufficient in iron or from blood loss. Blood loss can be acute as in hemorrhage or trauma or long term as in heavy menstruation.

Symptoms In general, anemia causes extreme fatigue, pale skin, weakness, shortness of breath, headache, lightheadedness, and often cold hands and feet. Iron deficiency anemia symptoms also may include: Inflammation or soreness of your tongue Brittle nails Unusual cravings for non-nutritive substances, such as ice, dirt or nonpure starch Poor appetite, especially in infants and children with iron deficiency anemia Some people with iron deficiency anemia experience restless legs syndrome an uncomfortable tingling or crawling feeling in your legs that's generally relieved by moving them. If you or your child develops signs and symptoms that suggest iron deficiency anemia, see your doctor. Initially, iron deficiency anemia can be so mild that it goes unnoticed. But as the body becomes more deficient in iron and anemia worsens, the signs and symptoms intensify

Treatments Increased intake of iron-rich foods is beneficial, but usually isn't ironenough to correct the problem. You need iron supplementation to build back your iron reserves, as well as to meet your body's daily iron requirements. In pregnant women, iron supplements help provide enough iron for both the mother and her fetus. For children or adults with mild iron deficiency anemia- doctors anemiamay recommend a daily multivitamin containing iron. But typically, doctors recommend iron tablets such as prescription ferrous sulfate tablets or an over-the-counter over-thesupplement. These oral iron supplements are usually best absorbed in an empty stomach. However, because iron can irritate your stomach, you may need to take the supplements with food. Your doctor may recommend that you take iron supplements with orange juice or with a vitamin C tablet. Vitamin C, in orange juice or tablet form, helps increase iron absorption.

Anemia of Renal Disease

Anemia of renal disease occurs in both acute and chronic renal failure. Renal excretory dysfunction and endocrine abnormalities play pathophysiologic roles. This is demonstrated by the build-up of uremic toxins and decreased builderythropoietin production, both of which adversely affect erythropoiesis. The accumulation of toxic metabolites, which are normally excreted by the kidneys, shortens the life span of circulating red blood cells. In fact, there is an inverse relationship between blood urea nitrogen (BUN) levels and red blood cell life span. More important, however, is the diminished renal production or the dysfunction of erythropoietin that results in decreased red blood cell production. Although the erythropoietin levels may be low, normal or high, they are inappropriately low when adjusted for the degree of anemia.

The anemia of renal disease is usually normocytic and normochromic, but microcytosis can also occur. Hemoglobin concentrations may be mildly decreased with lesser degrees of azotemia or markedly diminished in chronic renal failure (hemoglobin levels as low as 5 to 7 g per dL [50 to 70 g per L]). A variety of morphologic abnormalities can be seen, such as burr cells in cases of uremia; microcytic, hypochromic red blood cells despite normal iron stores; or schistocytes and thrombocytopenia in cases of disseminated intravascular coagulation or thrombotic thrombocytopenic purpura. Androgens were used in the past in an attempt to stimulate red blood cell production, but the administration of erythropoietin has effectively replaced this treatment. In patients with a relative deficiency of erythropoietin, both intravenous and subcutaneous administration of erythropoietin increases the reticulocyte count and red blood cell mass in a dose-related manner.3 doseEven when iron stores are adequate, iron supplementation is usually needed with erythropoietin administration because enhanced red blood cell production rapidly depletes the stores. Erythropoietin can be given three times per week, but higher dosages on a once-per-week basis may also be once-pereffective

Anemia of Chronic Disease

 

Anemia of chronic disease is a blood disorder that results from a medical condition that affects the production and lifespan of red blood cells. Increasingly referred to as "anemia of inflammation", is a form of anemia seen in chronic illness, e.g. from chronic infection, chronic immune activation, or malignancy. The precise pathophysiologic mechanism of ACD is unclear. The anemia is related more to decreased red blood cell production than to increased destruction. There is an impair ment in the transport of iron from iron storage sites, such as the liver and bone marrow, to red blood cells (Figure 2). Infection or inflammation may be responsible for the production of mediators (such as interleukin-1) that result in increased sequestration of interleukiniron in macrophages and hepatocytes. Additional factors are decreased levels of transferrin (TIBC) and competition with another transport protein (lactoferrin) that preferentially returns iron back to macrophages (Figure 2). Therefore, iron is present but inaccessible for use in the production of hemoglobin within erythrocytes. A poor response to or a relative decrease in erythropoietin production complicates the anemia.4 Finally, an unexplained slightly shortened red blood cell survival also contributes to the anemia.

. Diagram of iron kinetics from iron stores to developing red blood cell (RBC). Iron stores include the bone marrow, reticuloendothelial system (liver and spleen) and RBCs. Transferrin (total iron-binding capacity [TIBC]) irontransports iron (Fe) to developing erythrocytes. Iron is deposited in the RBC, and transferrin returns to storage sites to bind more Fe for transport. Lactoferrin is a competitor of transferrin; it takes Fe that is free and returns it to storage sites. Lactoferrin levels are elevated in anemia of chronic disease. Increases in interleukininterleukin-1 increase the sequestration of Fe in storage sites. (Hb=hemoglobin)

Sections of peripheral blood smears from two patients with anemia of chronic disease. (Left) Normal lymphocyte; normal red blood cell sizes approximate the diameter of a mature lymphocyte. The erythrocytes shown here are normal to mildly microcytic. (Right) Red blood cells here are also slightly microcytic; however, the polymorphonuclear leukocyte contains excessive granules (toxic granulation), which suggests an underlying infection or inflammation. (Oil immersion; 1,000)

Treatment
The ideal treatment for anemia of chronic disease is to treat the chronic disease successfully. Barring that, many patients with anemia of chronic disease simply live with the effects of the anemia as part of enduring the limits placed on them by other aspects of their underlying medical conditions. In more severe cases, transfusions or several versions of commerciallycommerciallyproduced erythropoietin can be helpful in some circumstances; both approaches are costly The treatment of ACD is directed at the underlying cause. Iron therapy is of no benefit. If necessary, transfusions or erythropoietin therapy can be considered when the degree of anemia poses cardiovascular problems. When ACD is associated with cancer, other factors may contribute to the anemia, such as transient bone marrow suppression from chemotherapy or bone marrow replacement by tumor. In patients with cancer, treatment with transfusions or erythropoietin is acceptable because of greater degrees of anemia and other complicating features such as bleeding, thrombocytopenia and relative deficiency of erythropoietin

Aplastic Anemia


is a condition where bone marrow does not produce sufficient new cells to replenish blood cells. cells. The term 'aplastic' means the marrow suffers from an aplasia that renders it unable to function properly. Anemia is the condition of having reduced hemoglobin or red cell concentration in the blood. Typically, anemia refers to low red blood cell counts, but aplastic anemia patients have lower counts of all three blood cell types: red blood cells, white blood cells, cells, cells, and platelets, termed pancytopenia. platelets, pancytopenia.

 

Signs and symptoms Anemia with malaise, pallor and associated malaise, symptoms Thrombocytopenia (low platelet counts), leading to increased risk of hemorrhage and bruising Leukopenia (low white blood cell count), leading to increased risk of infection

Patient with aplastic anemia

Clinical Manifestations
The manifstation of aplastic anemia are often insidious. Complications resulting from bone marrow failure may occur before the diagnosis is established. Typical complications are infection and symptoms of anemia (fatigue, pallor, dyspnea). Purpura (bruising) may develop after and should trigger a CBC and hematologic evaluation if these were not performed initially. If the patient has had repeated throat infections, cervical lymphadenopathy may be seen. Other lymphodenopathies and spleomegaly sometimes occur. Retinal hemorrhages are common.

Megaloblastic Anemia


anemia is an anemia (of macrocytic classification) which results from inhibition of DNA synthesis in red blood cell production. It is often due to deficiency of vitamin B12 and/or folic acid. It can acid. be the result of a lack of intrinsic factor (which lack interferes with B12 absorption), causing pernicious anemia, anemia, or with other antimetabolites which poison DNA production, such as chemotherapeutic agents. It is characterized by many large immature and dysfunctional red blood cells (megaloblasts) in the (megaloblasts) bone marrow,[1] and also by hypersegmented or marrow,[1] multisegmented neutrophils. neutrophils.

Signs and symptoms:  Loss of appetite  Diarrhea  Tingling and numbness of hand and feet  Pale skin color  Tiredness  Headaches  Sore mouth and tongue  Change in skin color

Patient with Megaloblastic Anemia

Hemolytic Anemia

Sickle Cell Anemia



is a blood disorder characterized by red blood cells that assume an abnormal, rigid, sickle shape. Sickling decreases the cells' flexibility and results in their restricted movement through blood vessels, depriving vessels, oxygen. downstream tissues of oxygen. The disease is chronic and lifelong: individuals are most often well, but their lives are punctuated by periodic painful attacks and a risk of various other complications. Life expectancy is shortened, with older studies reporting an average life expectancy of 42 and 48 years for males and females, respectively.[1] respectively.[1] SickleSickle-cell disease occurs more commonly in people (or their descendants) subAfrica, from parts of the world such as sub-Saharan Africa, where malaria is or was common, but it also occurs in people of other ethnicities. This is because those with one or two alleles of the sickle-cell disease are resistant sickleto malaria since the sickle red blood cells are not conducive to the parasites - in areas where malaria is common there is a survival value in carrying the sicklesickle-cell genes.

Signs and Symptoms Chronic hemolysis or thrombosis Hemoglobin values of 7-10g/dl 7Jaundice Bone marrow expand Tachycardia Cardiac murmurs Dysrythmias Heart failure

Patient with Sickle cell anemia

Nursing Intervention


 

Avoid situations that increase cellular metabolism; strenuous physical activity, contact sports, emotional stress, high altitudes, known sources of infection Report fever or mild infection at once to parents for them to seek medical attention immediately 3) Encourage fluid intake to prevent sickling and blood stasis # of glasses of water or fluids per day/ # in the school setting 4.)Maintain up to date immunization

Thalassemia
is an inherited autosomal recessive blood disease. disease. In thalassemia, the genetic defect results in reduced rate of synthesis of one of the globin chains that make up hemoglobin. hemoglobin. Reduced synthesis of one of the globin chains can cause the formation of abnormal haemoglobin molecules, and this in turn causes the anemia which is the characteristic presenting symptom of the Thalassemia.

Signs and Symptoms

        

     

Weakness. Fatigue. Lightheadedness. Skin that looks paler than normal. Jaundice (skin and whites of the eyes appear yellow). Dark urine. Decreased appetite and weight loss (poor growth in a child). A rapid heartbeat. Shortness of breath during exercise. Less common symptoms of severe thalassemia include: Headache. Belly pain. Ringing in the ears. Chest pain. A slight fever. A sore, smooth tongue.

Children with a more severe form of thalassemia (beta thalassemia major, or Cooley's anemia) usually develop symptoms of anemia within the first few months of life. Paler skin is often the first sign of the (failure thrive). disease.2 disease.2 Infants may grow slowly (failure to thrive). Other symptoms may include feeding problems, frequent fevers, and diarrhea. Without early treatment, a child may die or develop severe problems, such as:3 as:3 A deformed face caused by the bone marrow expanding in the bones. This may cause a bulging forehead (frontal bossing). An enlarged liver and spleen. spleen.

Patient with Thalassemia

Treatment
Blood Transfusions The most common treatment for all major forms of thalassemia is red blood cell transfusions. transfusions. These transfusions are necessary to provide the patient with a temporary supply of healthy red blood cells with normal hemoglobin capable of carrying the oxygen that the patient's body needs. While thalassemia patients were given infrequent transfusions in the past, clinical research led to a more frequent program of regular blood cell transfusions that has greatly improved the patients' quality of life. Today, most patients with a major form of thalassemia receive red blood cell transfusions every two to three weeks, amounting to as much as 52 pints of blood a year. Iron Overload Because there is no natural way for the body to eliminate iron, the iron in the transfused blood cells builds up in a condition known as "iron overload" and becomes toxic to tissues and organs, particularly the liver and heart. Iron overload typically results in the patient's early death from organ failure. Chelation Therapy To help remove excess iron, patients undergo "iron chelation therapy," in which a drug is introduce dinto the body which binds with excess iron and removes it through the urine or stool. For many years, the only FDA-approved iron chelator was Desferal, which has to be FDADesferal, administered through a painful and difficult infusion process. When using Desferal, a needle is attached to a small battery-operated infusion pump and worn under the skin of the stomach batteryor legs five to seven times a week for up to twelve hours.

Immune Hemolytic Anemia



Immune hemolytic anemia is a disorder characterized by anemia due to premature destruction of red blood cells by the immune system.

Symptoms  Fatigue  Pale or yellow skin color  Shortness of breath  Rapid heart rate  Dark urine  Enlarged spleen

Treatment Treatment with the steroid prednisone is the first therapy that is tried. If prednisone does not improve the condition, a splenectomy (removal of the spleen) may be considered. Treatments with drugs that suppress the immune system will be given if the person does not respond to prednisone and splenectomy. Blood transfusions, if indicated for severe anemia, are given with caution because of the potential that blood may not be compatible and it may precipitate a reaction.

Hereditary Hemocromatosis
Hereditary hemochromatosis (HH), the most common form of iron overload disease, is an inherited disorder that causes the body to absorb and store too much iron. Excess iron is stored throughout the body in organs and tissues including the pancreas, liver, and skin. Without treatment, the iron deposits can damage these organs and tissues.

 

         

Signs and Symptoms Some people who test positive for hereditary hemochromatosis remain symptomsymptom-free for life. Kids who test positive rarely have any symptoms because iron takes years to accumulate. Patients who do have symptoms may experience: muscle aches and joint pain, primarily in the fingers, knees, hips, and ankles; one of the earliest symptoms is arthritis of the knuckles of the first and second fingers chronic fatigue depression, disorientation, or memory problems stomach swelling, abdominal pain, diarrhea, or nausea loss of body hair, other than that on the scalp premature menopause gray or bronze skin similar to a suntan heart problems diabetes enlarged liver increased susceptibility to bacterial infections

With such a wide range of possible symptoms, the disease can be extremely difficult to diagnose. As symptoms progress, it's frequently misdiagnosed as chronic hepatitis, other forms of diabetes, Alzheimer's disease, iron deficiency, gallbladder illness, menstrual problems, thyroid conditions, or polycythemia (an increase in the number of red blood cells). It's important to understand that someone with hereditary hemochromatosis can have some symptoms without having all of them (i.e., heart problems without skin color changes, diabetes, or diabetes, liver problems).

Patient with Hereditary hemochromatosis

Treatment Treatment is simple, inexpensive, and safe. The first step is to rid the body of excess iron. The process is called phlebotomy, which means removing blood. Depending on how severe the iron overload is, a pint of blood is taken once or twice a week for several months to a year, occasionally longer. Blood ferritin levels are tested after every four phlebotomies to monitor iron levels. The goal is to bring blood ferritin levels to the low end of normal and keep them there (that means less than 9 to 50 micrograms of blood ferritin per liter). Depending on the amount of overload at diagnosis, reaching normal levels can take up to 100 phlebotomies. Once iron levels return to normal, maintenance therapy, which involves removing a pint of blood every 1 to 4 months for life, begins. Some people may need it more often. An annual blood ferritin test will help determine how often blood should be removed. The earlier hemochromatosis is diagnosed and treated, the better. If treatment begins before any organs are damaged, associated conditions such as liver disease, heart disease, arthritis, and diabetes can be prevented. Individuals who have already developed complications from hemochromatosis may not be cured but usually can be helped. The main exception is arthritis, which does not improve even after excess iron is removed. People with hemochromatosis should not take iron supplements. Those who have liver damage should not drink alcoholic beverages because they further damage the liver.

Polycythemia (or polycythaemia or erythrocytosis)

is a condition in which there is a net increase in cells, the total number of blood cells, primarily red blood cells, in the body.[1] The overproduction cells, body.[1] of red blood cells may be due to a primary process in the bone marrow (a so-called somyeloproliferative syndrome), or it may be a syndrome), reaction to chronically low oxygen levels or, malignancy. rarely, a malignancy.

The list of signs and symptoms mentioned in various sources for Polycythemia includes the 14 symptoms listed below:  No symptoms - in some patients  Headache  Tiredness  Breathlessness  Disturbed vision  Weakness  Dizziness  General itching  Flushing  Facial redness  Bloodshot eyes  Enlarged spleen  Bleeding spleen  Enlarged liver

Nursing management:


-Risk factors for thrombotic complications should be assessed, and patients should be instructed regarding the sings and symptoms of thrombosis. -patient with a history of bleeding are usually advised to avoid aspirin. -minimize alcohol intake should also be emphasized to further diminish any risk for bleeding.

Patient with Polycythemia

Leukopenia (or leukocytopenia, or leucopenia)

is a decrease in the number of circulating white blood cells (leukocytes) in the blood. As the blood. principal function of white cells is to combat infection, infection, a decrease in the number of these cells can place patients at increased risk for infection. infection.

          

Signs and Symptoms The first indications of leukemia often are nonspecific or vague. They may occur with other cancerous as well as noncancerous disorders. Although signs and symptoms vary for each type of leukemia, there are some general features. Broad symptoms of leukemia may include: Fatigue Malaise (vague feeling of bodily discomfort) Abnormal bleeding Excessive bruising Weakness Reduced exercise tolerance Weight loss Bone or joint pain Infection and fever Abdominal pain or "fullness" Enlarged spleen, lymph nodes, and liver

Patient with Leukopenia

Leukemia
-

cancer of the blood cells. It starts in the bone marrow, the soft tissue inside most bones. Bone marrow is where blood cells are made. When you are healthy, your bone marrow makes: White blood cells, which help your body fight infection. cells, Red blood cells, which carry oxygen to all parts of your body. cells, Platelets, Platelets, which help your blood clot. When you have leukemia, the bone marrow starts to make a lot of abnormal white blood cells, called leukemia cells. They don't do the work of normal white blood cells, they grow faster than normal cells, and they don't stop growing when they should. Over time, leukemia cells can crowd out the normal blood cells. This can anemia, lead to serious problems such as anemia, bleeding, and infections. Leukemia cells can also spread to the lymph nodes or other organs and cause swelling or pain.

    

Signs and Symptoms

       

 

Fevers and night sweats. Frequent or unusual infections. Weakness and fatigue. Headaches. Bruising of the skin and bleeding from the gums or rectum. Bone pain. Joint pain. Swelling in the belly or pain on the left side of the belly or in the left shoulder from a swollen spleen. spleen. Swollen lymph nodes in the armpit, neck, or groin. Decreased appetite and weight loss because you feel full and don't want to eat.

Treatment


Chemotherapy, Chemotherapy, which uses powerful medicines to kill cancer cells. This is the main treatment for most types of leukemia. Radiation treatments. Radiation therapy uses high-dose X-rays treatments. highXto destroy cancer cells and shrink swollen lymph nodes or an enlarged spleen. It may also be used before a stem cell transplant. Stem cell transplant. Donated stem cells can rebuild your transplant. supply of normal blood cells and boost your immune system. Before the transplant, radiation or chemotherapy is used to destroy cells in bone marrow and make room for donated cells. Biological therapy. This is the use of special medicines that therapy. improve your body's natural defenses against cancer

Patient with Leukemia

Agnogenic myeloid metaplasia



- a condition that occurs when the bone marrow is scarred, making it less likely to manufacture blood cells. When the bone marrow does not function properly, the spleen and liver will produce blood cells. As a result, the spleen and liver may become enlarged. Agnogenic myeloid metaplasia usually develops slowly. It most often occurs in people 50 years old and older. Agnogenic myeloid metaplasia leads to progressive bone marrow failure with severe anemia. Most people with agnogenic myeloid metaplasia become dependent on blood transfusions for survival.

Signs and Sypmtoms

     

rapid heart beat paleness enlarged spleen night sweats weight loss stuffed feeling after eating

Treatment


Only bone marrow transplantation has been shown to cure myelofibrosis. But other treatments can improve symptoms of the disease. Decreases in red and white blood cells and platelets can be treated with androgens, erythropoietin and thalidomide. An enlarged spleen can be helped in some lowcases with surgery, oral chemotherapy with hydroxyurea or low-dose radiation. radiation. These treatments have side effects and must be carefully managed so that the benefits outweigh the risks. Mayo physicians have significant clinical expertise in using currently available medications to treat myelofibrosis. Many clinical trials of medications have been performed at Mayo, including Suramin, Pirfenidone, InterferonInterferon-Alpha, Etanercept, Thalidomide, Thalidomide plus Prednisone, Imatinib Mesylate (Gleevec), Cladribine and Zarnestra. Additionally, Mayo Myelofibrosis) researchers (see Research on Myelofibrosis) are actively evaluating possible new therapies for myelofibrosis in the laboratory. Many clinical trials are currently under way for myelofibrosis and related diseases.

Patient with Agnogenic myeloid metaplasia

Lymphoma


is a type of solid neoplasm that originates in lymphocytes (a type of white blood cell in the vertebrate immune system). This is in contrast system). to lymphoid leukemia, which is a malignancy leukemia, of circulating cells.[1] cells.[1] There are many types of lymphoma. Lymphomas are part of the broad group of diseases called hematological neoplasms

Signs and Symptoms

        

Painless lymph node enlargement Fevers, night sweats, tiredness, weight loss >10% Widespread itching Nausea, vomiting, abdominal pain Shortness of breath, cough Headaches, vision changes, seizures Anaemia Susceptible to infections eg shingles Reddened patches on the skin

Pain Management


Pain relief is not the only goal of pain management. It is also intended to help you maintain your normal quality of life throughout your lymphoma treatment. At CTCA, your care team will incorporate various pain management techniques into your lymphoma cancer treatment plan. All methods of pain management attempt to either control the cause of the pain or alter your perception of it. Although there are several different pain management techniques, therapeutic approaches can be classified as either pharmacological or non-pharmacological. Pharmacological nonpain control involves the use of pain medications (analgesics), along with other medications that either intensify the analgesics' effects or modify your mood or pain perception.

The following are some non-pharmacological nonapproaches to pain management:  Behavioral techniques  Emotional counseling and support  Radiation to shrink the tumor  Surgery to remove part or all of the tumor  Neurological and neurosurgical interventions  Traditional nursing and psychosocial interventions

Multiple myeloma
(plasma cell myeloma Kahler's disease )

is a type of cancer of plasma cells which are immune system cells in bone marrow that produce antibodies. Myeloma is regarded as antibodies. incurable, but remissions may be induced with steroids, chemotherapy, steroids, chemotherapy, thalidomide and stem cell transplants. Myeloma is part of the broad transplants. group of diseases called hematological malignancies. malignancies.

Signs and Symptoms

Because many organs can be affected by myeloma, the symptoms and signs vary greatly. A mnemonic sometimes used to remember the common tetrad of multiple myeloma is CRAB - C = Calcium (elevated), R = Renal failure, A = Anemia, B = Bone lesions.[1] Myeloma has many possible lesions.[1] symptoms, and all symptoms may be due to other causes. They are presented here in decreasing order of incidence. Bone pain, often in the back or ribs Broken bones Weakness or fatigue Weight loss Repeated infections

    

Treatment


  

Myeloma is not yet considered curable, but is an increasingly treatable condition. Treatments are focused on: controlling the disease prolonging survival improving symptoms so that patients can live with myeloma and have the best possible quality of life. In addition to direct treatment of the plasma cell proliferation, bisphosphonates (e.g. pamidronate or zoledronic acid) are routinely administered to prevent acid) fractures and erythropoietin to treat anemia.

Bleeding Anemia

Primary thrombocythemia


Primary thrombocythemia is the overproduction of platelets without a recognizable cause. Platelets are essential for blood clotting.

Signs and Symptoms

         

Bleeding from the gastrointestinal tract Bleeding from the gums Bloody stools Dizziness Easy bruising Enlarged lymph nodes (rare) Headache Nosebleeds (epistaxis) (epistaxis) Numbness of hands or feet Prolonged bleeding from surgical procedures or tooth extraction Ulcers on fingers or toes

Nursing management


Patients with primary thrombocythemia need to be instructed about the accompanying risks of hemorrhage and thrombosis. The patient is informed about signs and symptoms of thrombosis, particularly the neurologic n\manifestations, such as visual changes, numbness, tingling, and weakness. Risk factors for thrombosis are assessed, and measures to diminish risk factors are encouraged. Patients receiving aspirin therapy should be informed about the increased risk of bleeding. Patients who are at risk for bleeding should be instructed about medications ( eg, aspirin, NSAIDs ) and other substances ( eg, alcohol ) that can alter platelet function. Patients receiving interferon therapy are taught to self-administer selfthe medication and manage side effects

Patient with Thrombocythemia

THROMBOCYTOSIS (Secondary Thrombocythemia)

Thrombocytosis can develop secondary to chronic inflammatory disorders, acute infection, hemorrhage, iron deficiency, hemolysis, or tumors. Platelet function is usually normal. However, in myeloproliferative disorders, abnormalities of platelet aggregation occur in about 50% of patients. Unlike ET, thrombocytosis does not increase the risk of thrombotic or hemorrhagic complications unless patients have severe arterial disease or prolonged immobility. With secondary thrombocytosis, the platelet count is usually < 1,000,000/ L, and the cause may be obvious from the history, physical examination, or radiologic or blood testing. Treatment of the underlying disorder usually returns the platelet count to normal.

Signs and symptoms



High platelet levels do not necessarily signal any clinical problems, and are picked up on a routine full blood count. count. However, it is important that a full medical history be elicited to ensure that the increased platelet count is not due to a secondary process. Often, it occurs in tandem with an inflammatory disease, as the principal stimulants of platelet disease, thrombopoietin) production (e.g. thrombopoietin) are elevated in these clinical states as part of the acute phase reaction. reaction. High platelet counts can occur in patients with polycythemia vera (high red blood cell counts), and is an additional risk factor for complications. A very small segment of patients report symptoms of erythromelalgia, erythromelalgia, a burning sensation and redness of the extremities that resolves with cooling and/or aspirin use.

Patient with Secondary Thrombocythemia

Thrombocytopenia


Thrombocytopenia (or -paenia, or thrombopenia in short) is the presence of relatively few platelets in blood. blood. Generally speaking, in humans, a normal platelet count ranges from 150,000 and 450,000 per mm3 (microlitre).[1] (microlitre).[1] These limits, however, are determined by the 2.5th lower and upper percentile, and a percentile, deviation does not necessarily imply any form of disease. The number of platelets in a blood sample also decreases rather quickly with time and a low platelet count may be caused by a delay between sampling and analysis.

Signs and symptoms

 

    

Easy or excessive bruising Superficial bleeding into the skin that appears as a rash of pinpoint-sized reddish-purple spots pinpointreddish(petechiae), usually on the lower legs Prolonged bleeding from cuts Spontaneous bleeding from your gums or nose Blood in urine or stools Unusually heavy menstrual flows Profuse bleeding during surgery

Treatment


If your platelet count is low, your doctor may recommend avoiding drugs such as aspirin, which may impair platelet function, and avoiding excessive alcohol intake. You may also wish to avoid contact sports, which can put you at a higher risk of injury and bleeding. Sometimes, treatment for thrombocytopenia isn't necessary, particularly in children. In these cases, the bone marrow may make up for the shortage of platelets by producing large numbers of new ones until the initiating cause subsides. Young platelets are especially active in clotting, so even though the total concentration of platelets is low, your child may not experience any bleeding problems and need no special treatment. Mild thrombocytopenia in pregnant women usually improves soon after childbirth. If your doctor can identify the cause of thrombocytopenia, then the approach is to treat the underlying condition or stop using the problem medication.

Treating thrombocytopenia may involve several options:  Medications. For idiopathic thrombocytopenic purpura, treatment may include medications that block the antibodies that attack platelets, such as corticosteroids. Intravenous immunoglobulin may be used when rapid elevation of your platelet count is needed. If corticosteroids don't help, your doctor may recommend medications that suppress your immune system to reduce antibody formation, such as cyclophosphamide (Cytoxan) or azathioprine (Imuran).  Surgery. Sometimes, removing the spleen (splenectomy) relieves signs and symptoms or helps improve chronic idiopathic thrombocytopenic purpura that doesn't respond to corticosteroids.  Blood transfusions and plasma exchange. For severe bleeding, your doctor can replace lost blood with transfusions of packed red blood cells. Platelet concentrates are given to treat severe thrombocytopenia, particularly those related to cancer or chemotherapy.  Thrombotic thrombocytopenic purpura requires emergency treatment with plasma exchange therapy or therapeutic plasmapheresis. If you have hemolytic uremic syndrome, you may need kidney dialysis in addition to red blood cell and platelet

Patient with Thrombocytopenia

Idiopathic thrombocytopenic purpura (ITP)



Idiopathic thrombocytopenic purpura (ITP), also called immune thrombocytopenic purpura, is a bleeding disorder in which your blood has difficulty clotting due to an unusually low number of platelets. Platelets (thrombocytes) are colorless blood cells that stop blood loss by clumping together at the site of a blood vessel injury and forming plugs in vessel holes. People with idiopathic thrombocytopenic purpura, because of their low platelet count, tend to bruise easily and bleed longer when injured. Nosebleeds and bleeding gums also are common. Idiopathic thrombocytopenic purpura is often divided into two categories: acute and chronic. Acute ITP is the most common form and occurs most frequently in children, typically after a viral infection. It usually goes away on its own within six months. Chronic ITP lasts longer than six months and is more common in adults.

Signs and Symptoms

  

Bruising Nosebleed or bleeding in the mouth Bleeding into the skin - also called pinpoint red spots or petechial rash Abnormally heavy menstruation

Interventions
 

 

Prehospital care focuses on the ABCs, which include providing oxygen, controlling severe hemorrhage, and initiating intravenous (IV) fluids to maintain hemodynamic stability. Prehospital airway control may be necessary for a large intracranial hemorrhage. EMS providers should be aware of the potential for serious bleeding complications in patients with idiopathic thrombocytopenic purpura (ITP). LifeLife-threatening bleeding requires conventional critical care interventions. In the patient with known ITP, high-dose parenteral glucocorticoids and IV highimmunoglobulin (IVIg), with or without platelet transfusions, are appropriate. Platelet transfusion is indicated for controlling severe hemorrhage. Send a blood specimen to the lab for type and screen in case platelet transfusion is necessary. Platelet survival is increased if the platelets are transfused immediately after IVIg infusion. A consultation with a hematologist may be required to make a decision regarding the transfusion of platelets.

Platelet defect
Acquired platelet function defects are diseases or conditions that cause the platelets (the blood cells essential for clotting) to not work properly. The term "acquired" means these diseases or conditions are not inherited, but rather develop independently in a person.

Symptoms
 

Abnormal color of urine (blood in the urine) urine) Abnormal menstrual periods
 

Heavy menstrual periods Prolonged menstrual bleeding (more than five days per menstrual period)

  

Abnormal vaginal bleeding Bleeding under the skin or in the muscles (soft tissues) Gastrointestinal bleeding
 

Bloody, dark black, or tarry bowel movements Vomiting blood or vomiting material that resembles coffee grounds

  

Nosebleeds Prolonged bleeding, easy bruising Skin rash

  

Multiple lesions Bruises Pinpoint red spots

Intervention
Treatment is directed at the cause of the abnormality. Dialysis reduces the bleeding tendency if the cause is renal failure. Platelet transfusions or plateletpheresis (removal of platelets from the blood and replacement with donated platelets) may be needed in bone marrow disorders. Medication-induced platelet Medicationabnormalities require stopping the medication

Congenital platelet function defects

Congenital platelet function defects are problems with the blood cells that are needed for blood clotting. Congenital means present from birth.

Symptoms
     

Nosebleeds Bleeding during and after surgery Easy bruising Prolonged bleeding with small injuries Abnormal menstrual periods Bleeding gums

Intervention


There is no specific treatment for these disorders. All people with bleeding disorders should avoid taking aspirin because it is known to prolong bleeding time -- the time it takes to form clotting mechanisms in the blood. Platelet transfusions may be given when patients have severe bleeding