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THROMBOCYTOPENIA

Thrombocytopenia is characterised by a low platelet count within the blood. Platelets are manufactured within the Bone Marrow are essential for maintaining haemostasis or in more simpler terms the bodies ability to clot and protect itself from haemorrhage. Thrombocytopenia can be a life threatening condition if not addressed.

WHAT CAUSES THROMBOCYTOPENIA?

 There is no breed, age or sex prevalence concerning this condition. There are five main types of cause:

1) Decreased production of platelets -  This can be caused by types of medication such as oestrogen meds or chloramphenicol. However, the most common cause is aplastic anaemia which occurs when there is a failure in the bone marrow or when the patient is suffering from Leukaemia. Cancer patients undergoing chemotherapy and radiation can also suffer from this type of thrombocytopenia. 

2) Increased blood clotting - Increased blood clotting can be caused by several conditions such as Disseminated Intravascular Coagulation where blood clots form in small blood vessels resulting in poor tissue perfusion and ultimately organ damage. Endotoxic shock can also cause this as well and vasculitis and certain types of cancer i.e Haemangiosarcoma.

3) Destruction of platelets - This is usually caused by autoimmune disease, where the bodies own immune system attacks and destroys its own platelets.This type of condition is more common in dogs and rarely seen in cats. Platelets can also be prematurely destroyed if the patient is suffering from diseases such as Ehrlichiosis and Babesiosis caused by infected tick bites and Heartworm. 

4) Sequestration (The removal of platelets from circulation) - Splenomegaly or a splenic torsion can cause the spleen to function abnormally and in some cases collect and retain up to 90% of the total platelet volume.

5) Haemorrhage due to trauma

WHAT ARE THE CLINICAL SIGNS?

Pyrexia

Lethargy and appetite loss

Heart Murmur

Haematuria

Excessive coughing

Epistaxsis

Collapse

Petechiae - pinpoint haemorrhages usually seen on the mucus membranes

Bruising easily

Melena or fresh blood in stools

HOW DO YOU DIAGNOSE THROMBOCYTOPENIA?

Taking a full clinical history to rule out a recent trauma is important as they will enable the clinician to rule out internal haemorrhage due to trauma, in addition information can be gathered to access whether the patient could be suffering from any infectious disease or have contracted any disease such as Babesiosis.Full blood analysis to include biochemistry, haematology and coagulation times should be carried out, in addition to this a 4DX profile testing for 6 vector-bourne diseases is recommended. Radiographs and Abdominal ultrasound can rule our internal haemorrhage and allow for a cancer screen. Additionally a bone marrow aspirate can be carried out. 

WHAT TREATMENT IS AVAILABLE?

In severe cases a blood transfusion is recommended, however in the UK the only source of platelets is from a whole blood transfusion. This must be carried out within four hours of collection and only when the platelet count is very low and bleeding into areas such as the respiratory system is evident. This is a salvage procedure and unfortunately very rarely makes a difference in severely thrombocytopenia patients due to the lack of active platelets in one unit of whole blood. 

In patients suffering from immune mediated thrombocytopenia, steroids or other immunosuppressing drugs are used and often these can successfully control the condition, although relapses are common. 

NURSING CONSIDERATIONS

Careful handling and minimal restraint

No neck leads to prevent pulling and avoidable bruising around the neck

No jugular/arterial blood sampling to prevent haemorrhage