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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 usually caused by a diet insufficient in iron or from blood loss. .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. Blood loss can be acute as in hemorrhage or trauma or long term as in heavy menstruation.

pale skin. the signs and symptoms intensify . see your doctor. anemia causes extreme fatigue. shortness of breath. If you or your child develops signs and symptoms that suggest iron deficiency anemia. such as ice. lightheadedness. weakness. Initially. dirt or nonpure starch Poor appetite. headache. But as the body becomes more deficient in iron and anemia worsens. iron deficiency anemia can be so mild that it goes unnoticed. and often cold hands and feet.Symptoms In general. Iron deficiency anemia symptoms also may include: Inflammation or soreness of your tongue Brittle nails Unusual cravings for non-nutritive substances. especially in infants and children with iron deficiency anemia Some people with iron deficiency anemia experience restless legs syndrome ² an uncomfortable tingling or crawling feeling in your legs that's generally relieved by moving them.

For children or adults with mild iron deficiency anemia. iron supplements help provide enough iron for both the mother and her fetus. These oral iron supplements are usually best absorbed in an empty stomach. You need iron supplementation to build back your iron reserves. However. but usually isn't ironenough to correct the problem. because iron can irritate your stomach. Vitamin C. doctors recommend iron tablets ² such as prescription ferrous sulfate tablets or an over-the-counter over-thesupplement. 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. helps increase iron absorption. But typically. in orange juice or tablet form.doctors anemiamay recommend a daily multivitamin containing iron. In pregnant women.Treatments Increased intake of iron-rich foods is beneficial. as well as to meet your body's daily iron requirements.

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

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

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.g. Additional factors are decreased levels of transferrin (TIBC) and competition with another transport protein (lactoferrin) that preferentially returns iron back to macrophages (Figure 2).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. an unexplained slightly shortened red blood cell survival also contributes to the anemia. to red blood cells (Figure 2). is a form of anemia seen in chronic illness. from chronic infection. . Increasingly referred to as "anemia of inflammation".4 Finally. There is an impair ment in the transport of iron from iron storage sites. 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. e. Therefore. The anemia is related more to decreased red blood cell production than to increased destruction. or malignancy. such as the liver and bone marrow. chronic immune activation. The precise pathophysiologic mechanism of ACD is unclear.

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

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however.Sections of peripheral blood smears from two patients with anemia of chronic disease. normal red blood cell sizes approximate the diameter of a mature lymphocyte. which suggests an underlying infection or inflammation. (Oil immersion. (Left) Normal lymphocyte. (Right) Red blood cells here are also slightly microcytic. The erythrocytes shown here are normal to mildly microcytic. the polymorphonuclear leukocyte contains excessive granules (toxic granulation). × 1.000) .

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

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

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

Patient with aplastic anemia .

Clinical Manifestations The manifstation of aplastic anemia are often insidious. Other lymphodenopathies and spleomegaly sometimes occur. dyspnea). cervical lymphadenopathy may be seen. Complications resulting from bone marrow failure may occur before the diagnosis is established. Typical complications are infection and symptoms of anemia (fatigue. pallor. . Retinal hemorrhages are common. 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.

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

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 .

Sickling decreases the cells' flexibility and results in their restricted movement through blood vessels. depriving vessels. rigid. respectively. oxygen. where malaria is or was common. 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 . from parts of the world such as sub-Saharan Africa. The disease is chronic and lifelong: individuals are most often well.[1] SickleSickle-cell disease occurs more commonly in people (or their descendants) subAfrica. with older studies reporting an average life expectancy of 42 and 48 years for males and females. downstream tissues of oxygen. sickle shape.Sickle Cell Anemia  is a blood disorder characterized by red blood cells that assume an abnormal. but it also occurs in people of other ethnicities. Life expectancy is shortened.in areas where malaria is common there is a survival value in carrying the sicklesickle-cell genes. but their lives are punctuated by periodic painful attacks and a risk of various other complications.  .[1] respectively.

‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ 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. 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. emotional stress. high altitudes.)Maintain up to date immunization . strenuous physical activity. contact sports.

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

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

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

Patient with Thalassemia .

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. Iron Overload Because there is no natural way for the body to eliminate iron. For many years. While thalassemia patients were given infrequent transfusions in the past. particularly the liver and heart." in which a drug is introduce dinto the body which binds with excess iron and removes it through the urine or stool. 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. . the only FDA-approved iron chelator was Desferal. Iron overload typically results in the patient's early death from organ failure. Today. administered through a painful and difficult infusion process.Treatment Blood Transfusions The most common treatment for all major forms of thalassemia is red blood cell transfusions. Chelation Therapy To help remove excess iron. transfusions. the iron in the transfused blood cells builds up in a condition known as "iron overload" and becomes toxic to tissues and organs. clinical research led to a more frequent program of regular blood cell transfusions that has greatly improved the patients' quality of life. When using Desferal. patients undergo "iron chelation therapy. which has to be FDADesferal. 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.

Symptoms  Fatigue  Pale or yellow skin color  Shortness of breath  Rapid heart rate  Dark urine  Enlarged spleen .Immune Hemolytic Anemia  Immune hemolytic anemia is a disorder characterized by anemia due to premature destruction of red blood cells by the immune system.

. a splenectomy (removal of the spleen) may be considered. Blood transfusions.  Treatment Treatment with the steroid prednisone is the first therapy that is tried. If prednisone does not improve the condition. 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. Treatments with drugs that suppress the immune system will be given if the person does not respond to prednisone and splenectomy.

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

diarrhea. disorientation. 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 . one of the earliest symptoms is arthritis of the knuckles of the first and second fingers chronic fatigue depression. primarily in the fingers.             Signs and Symptoms Some people who test positive for hereditary hemochromatosis remain symptomsymptom-free for life. abdominal pain. hips. Kids who test positive rarely have any symptoms because iron takes years to accumulate. and ankles. Patients who do have symptoms may experience: muscle aches and joint pain. knees. or nausea loss of body hair. or memory problems stomach swelling.

 

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 .

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

Patient with Polycythemia .

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

Although signs and symptoms vary for each type of leukemia. and liver . 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. They may occur with other cancerous as well as noncancerous disorders.            Signs and Symptoms The first indications of leukemia often are nonspecific or vague. there are some general features. lymph nodes.

Patient with Leukopenia .

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

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

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

Patient with Leukemia .

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

Signs and Sypmtoms       rapid heart beat paleness enlarged spleen night sweats weight loss stuffed feeling after eating .

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

Patient with Agnogenic myeloid metaplasia .

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

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

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. 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. It is also intended to help you maintain your normal quality of life throughout your lymphoma treatment.Pain Management   Pain relief is not the only goal of pain management. . therapeutic approaches can be classified as either pharmacological or non-pharmacological. your care team will incorporate various pain management techniques into your lymphoma cancer treatment plan. At CTCA.

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 .

incurable. malignancies. chemotherapy. but remissions may be induced with steroids.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 part of the broad transplants. group of diseases called hematological malignancies. thalidomide and stem cell transplants. Myeloma is regarded as antibodies. chemotherapy. steroids.

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

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. bisphosphonates (e. In addition to direct treatment of the plasma cell proliferation.Treatment      Myeloma is not yet considered curable.g. . pamidronate or zoledronic acid) are routinely administered to prevent acid) fractures and erythropoietin to treat anemia.

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Bleeding Anemia .

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

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 .

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

Patient with Thrombocythemia .

thrombocytosis does not increase the risk of thrombotic or hemorrhagic complications unless patients have severe arterial disease or prolonged immobility.000/ L. hemorrhage. Unlike ET. the platelet count is usually < 1.000. physical examination.THROMBOCYTOSIS (Secondary Thrombocythemia) Thrombocytosis can develop secondary to chronic inflammatory disorders. abnormalities of platelet aggregation occur in about 50% of patients. acute infection. or tumors. Platelet function is usually normal. . Treatment of the underlying disorder usually returns the platelet count to normal. in myeloproliferative disorders. With secondary thrombocytosis. However. hemolysis. and the cause may be obvious from the history. or radiologic or blood testing. iron deficiency.

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

Patient with Secondary Thrombocythemia .

or thrombopenia in short) is the presence of relatively few platelets in blood. .[1] (microlitre). deviation does not necessarily imply any form of disease.5th lower and upper percentile. blood. Generally speaking.Thrombocytopenia   Thrombocytopenia (or -paenia. however. are determined by the 2. a normal platelet count ranges from 150. and a percentile.000 and 450.000 per mm3 (microlitre). 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. in humans.[1] These limits.

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 .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).

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

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

Patient with Thrombocytopenia .

It usually goes away on its own within six months. 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. Chronic ITP lasts longer than six months and is more common in adults. also called immune thrombocytopenic purpura. 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. Nosebleeds and bleeding gums also are common. is a bleeding disorder in which your blood has difficulty clotting due to an unusually low number of platelets.Idiopathic thrombocytopenic purpura (ITP)  Idiopathic thrombocytopenic purpura (ITP). People with idiopathic thrombocytopenic purpura. tend to bruise easily and bleed longer when injured. because of their low platelet count. typically after a viral infection.   .

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

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

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

or tarry bowel movements Vomiting blood or vomiting material that resembles coffee grounds    Nosebleeds Prolonged bleeding.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. easy bruising Skin rash    Multiple lesions Bruises Pinpoint red spots . dark black.

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.Intervention Treatment is directed at the cause of the abnormality. Medication-induced platelet Medicationabnormalities require stopping the medication .

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

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

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