Management of Select Thrombocytopenias.

Evaluating, diagnosing, and managing patients with consumptive thrombocytopenia is challenging because of the overlapping nature of many of the diseases that reduce platelet counts. Immune thrombocytopenia (and its variations), drug-induced immune thrombocytopenia, and heparin-induced thrombocytopenia result from autoimmune antibody-mediated destruction of platelets. Thrombotic thrombocytopenia (both congenital and acquired) and the hemolytic uremic syndromes (both typical and atypical) are thrombotic microangiopathies associated with platelet aggregation and consumption along with anemia and renal dysfunction. Rapid history taking, physical assessment, and laboratory evaluation are crucial to accurately managing patients with these disorders. Platelet-associated coagulopathies are infrequently encountered by most providers, and limited exposure to these types of patients, combined with the wide variety of treatment options for reversing bleeding or thrombotic sequelae, makes management difficult. This article reviews the pathophysiology, patient presentation, diagnostic testing, and specific management strategies and challenges of these thrombocytopenias.

Nurses' role in platelet transfusion clinical trials.

This article describes the crucial role of research nurses in studies coordinated by the NHS Blood and Transplant Clinical Trials Unit (CTU), using two recent trials studying platelet transfusions in adults and neonates as examples. CTU studies are coordinated by trial managers, most of whom are or were registered nurses, which supports relationships with research nurses in participating hospitals. During trials the CTU sustains research nurses with ongoing education and training, and establishes cooperative working between nurses and the unit, and between nurses in different locations. Regular feedback from research nurses guides the design and management of clinical trials.

Pancitopenia en un canino ocasionada por la administración de estrógenos para evitar una preñez no deseada / Pancytopenia in a canine caused for administration of estrogens to avoid a not wanted pregnancy

Objetivo. Presentar el caso clínico de una paciente canina pancitopenica debido al uso indebido de estrógenos como método anticonceptivo. Materiales y métodos. Paciente canina de raza Poodle de 8 años, la cual fue llevada a consulta por presentar decaimiento, inapetencia, hemorragias petequiales e hipema. Resultado. Una vez realizada la anamnesis, el examen físico y los exámenes paraclínicos así como la evolución del cuadro clínico se demostró la intoxicación estrogénica exógena como diagnóstico definitivo. Conclusiones. El uso de estrógenos como método para la terminación de preñez en perras no está recomendado o considerado ético para muchos autores o asociaciones veterinarias por varias razones como: una dosis de estrógenos aparentemente efectiva no se ha establecido, por lo que su administración puede resultar en enfermedad uterina; dosis de estrógenos aparentemente seguras fueron determinadas como inseguras, y dosis aparentemente efectivas produjeron enfermedad uterina. La aplasia medular es un resultado común de la intoxicación estrogénica y esta puede conducir incluso a la muerte del paciente.

Treatment of heparin-induced thrombocytopenia: a practical argatroban dosing protocol for nurses.

Heparin-induced thrombocytopenia (HIT) is a serious complication of heparin therapy that frequently leads to thrombosis. In patients with HIT, heparin should be discontinued immediately, and rapid-acting, alternative anticoagulation should be initiated. Argatroban is a parenteral direct thrombin inhibitor approved for prophylaxis or treatment of thrombosis in HIT. In this article, the recognition and treatment of HIT is discussed, and a practical dosing protocol for argatroban therapy that has been developed and used successfully by the nurses and physicians at Holy Cross Hospital in Ft. Lauderdale, Florida, is presented.

Hematology in palliative medicine.

Advanced cancer and life-limiting chronic nonmalignant diseases are associated with a number of hematological problems. Anemia and coagulation disorders, principally venous thrombosis and thrombocytopenia, are most commonly observed. Patients undergoing chemotherapy and bone marrow transplant have unique problems that include neutropenias and chemotherapy-induced drug toxicities, which will not be covered in this article.

Alloimmune thrombocytopenia in the fetus: current management theories.

Fetal alloimmune thrombocytopenia (AIT) affects only a small number of fetuses but the consequences may be devastating. Outcomes range from mild thrombocytopenia without signs or symptoms to intracranial hemorrhage (ICH) and fetal or neonatal death. Antenatal screening is available but not used routinely in the United States. The most frequent method of AIT identification is its diagnosis in the neonatal period (index neonate). AIT may be diagnosed antenatally if an ICH is noted on routine obstetric ultrasound. There are accurate predictors of AIT, as well as antenatal therapies, to prevent the occurrence of severe disease and ICH.

Heparin-induced thrombocytopenia--recognition and treatment.

Heparin, an important agent for the prophylaxis and treatment of venous and arterial thromboembolism, also can cause heparin-induced thrombocytopenia (HIT). This medication-induced immune-mediated syndrome is characterized by thrombocytopenia and life- or limb-threatening thrombotic events. The initial presentation of HIT is a decrease in platelet count with or without thrombosis. Heparin-induced thrombocytopenia frequently is overlooked in hospital settings, and it must be distinguished from other causes of thrombocytopenia. New therapies include the use of direct thrombin inhibitors argatroban and hirudin.

Nursing considerations for managing topotecan-related hematologic side effects.

Topotecan (Hycamtin, SmithKline Beecham, Philadelphia, PA) was approved by the U.S. Food and Drug Administration in 1996 for use in relapsed ovarian cancer and in 1999 for platinum-sensitive small-cell lung cancer. Hematologic toxicity has been the predominant side effect associated with its use. Patients who have had extensive platinum-based therapy have exhibited increased degrees of thrombocytopenia and more severe neutropenia. These adverse events can be managed by identifying high-risk patients (i.e., those with more than six cycles of chemotherapy containing an alkylating agent or radiation to more than 25% of marrow-bearing bones, patients with a history of myelosuppression or renal impairment) and by recommending appropriate dose modifications based on the creatinine clearance measurement. By reducing the topotecan dose, myelosuppressive effects, as evidenced by neutropenia and thrombocytopenia, may be lessened or prevented without reducing the antitumor response.

Heparin-induced thrombocytopenia.

Heparin-induced thrombocytopenia is a rare but complex adverse drug reaction that can produce devastating results. Treatment and clinical management of the patient requires close observation and education of the pathophysiology occurring at the cellular level. Documented cases of heparin-induced thrombocytopenia have been reported in the literature for years. This case presentation details a multiple trauma patient in whom heparin-induced thrombocytopenia developed and the effect this syndrome had on her treatment and eventual recovery.

Heparin-associated thrombocytopenia: nursing implications.

Because of the potential severity of the associated complications, nurses have an essential role in the care of patients with HAT. Bedside nurses have the opportunity to report information that may indicate a change in a patient's condition after administration of heparin. This information could lead to diagnosis of heparin sensitivity and prompt treatment to decrease the associated thrombotic complications. Once HAT is diagnosed, a variety of resources are available as the patient's condition evolves. Primary concerns include determining effective strategies to provide appropriate skin care, educating the patient and the patient's family members, and providing effective continuity of care. Continuity of care is essential to maintain the patient's physical and emotional status and should be provided by a multidisciplinary team that includes physical and occupational therapists, skin care specialists, and clinical nurse specialists. Future topics for nursing research on HAT include the education of nurses, patients, and families about HAT; the most effective nursing interventions; and appropriate treatment for ischemic extremities. By knowing how to respond safely and effectively to a patient's sensitivity to heparin, critical care nurses can have a beneficial impact on the patient's care.

Thrombocytopenia.

Determining the true cause of thrombocytopenia is a difficult and challenging clinical problem. Thrombocytopenia results from various causes, but ultimately occurs when platelets are destroyed, sequestered in the body, or not produced. The differential diagnosis of thrombocytopenia is extensive and complex, and there is a significant overlap among disorders. The advanced practice nurse must take a holistic approach to the patient, eliciting a detailed history and performing a comprehensive physical examination with special emphasis on the skin, abdominal, lymph node and neurologic consideration.