THROMBOTIC THROMBOCYTOPENIC PURPURA

PATHOPHYSIOLOGY

• rare blood disorder ;deficiency of ADAMTS13 (enzyme) ; not having enough enzymes -> clotting occurs
• blood clots form in small blood vessels throughout the body
• can limit/block the flow of oxygen-rich blood to the body's organs, such as the brain, kidneys
• Increased clotting that occurs in TTP also uses up platelets (PLATE-lets) in the blood
• Low platelets counts = thrombocytopenia. ->bleeding

CAUSED BY

• TTP Can be inherited or acquired
• Secondary causes are Cancer,Chemotherapy, Hematopoietic stem cell transplantation,HIV infection,Hormone replacement therapy and estrogens; Medicines (including ticlopidine, clopidogrel, and cyclosporine A)
• Acquired TTP, adamts13 is not faulty; while adamts13 is faulty in inherited TTP

SIGNS & SYMPTOMS

• Purplish bruises on the skin or mucous membranes, called purpura; this mean there's bleeding under the skin
• Pinpoint-sized red or purple dots on the skin, called petechiae, bleeding is occurring the skin
• Paleness or jaundice
• Fatigue, oliguria, proteinuria
• Fever, headache, speech problems
• Tachycardia or shortness of breato
• confusion, coma, stroke, or seizure

NURSING CARE PLAN

ASSESSMENT

• Assess mucous membranes for signs of bleeding or trauma
• Assess neurological status, DTR, abdominal sounds , capillary refills
• Assess apical pulse
• Assess distal extremity pulses
• Assess bowel sounds
• Assess vitals: respiratory rate , BP, pulse , temp.02 Sat
• Assess skin for any bruising or wounds

PETECHIAE

DX STUDIES :
CBC COUNT
BUN/ CREATINE
PERIPHERAL BLOOD SMEAR: INDICATES SCHISTOCYTES
lactate dehydrogenase level (LDH)
ADAMTS 13 enzyme level test

Risk for Injury
Fatigue R/t decreased RBC secondary to shiscocytes
Rick For Bleeding

EXPECTED OUTCOMES

• Within 8 hours of nursing interventions,client will have no signs of bleeding.
• Within 8 hours of nursing interventions, client will have no episodes of falls.
• Within 8 hours of nursing interventions, client will get adequate rest and will report less fatigue.

INTERVENTIONS

• Locate patient in a room close to nurse station
• Observe closely for any signs of bleeding, changes in neurological status and report promptly
• Monitor all stools for blood
• Teach client to Use a soft bristle tooth brush and avoid dental floss & use electric shaver
• Transfuse blood cells (Platelets, fresh frozen plasma or Packed Red Blood Cell) as ordered
• Teach patient to avoid any activity likely to result in being bumped, scratched, or scraped
• Don't take aspirin or aspirin containing products

INTERVENTIONS (CON'T)

• Instruct patient to avoid some medications that increase bleeding tendency such as aspirin and ibuprofen
• Monitor platelet count and coagulation test results; Report abnormal values.
• If bleeding occurs and does not subside, apply firm & prolonged pressure to bleeding area * Use stool softener 2 prevent straining during bowel movement
• if epistaxis occurs, place in high Fowler's position, apply pressure & ice pack to nasal area *

INTERVENTIONS ( CON'T)

• Avoid any per rectal medication (Suppository) enemas, vaginal douches
• Monitor CBC , Urine output; strict monitoring of I& O, Vital Signs : BP,HR,temp.,02 sat, RR
• Teach patient about plasmapheresis: removal of affected plasma and replacement of plasma or a plasma substitute
• Encourage patient to take rest periods
• Avoid nose blowing/ if you must blow, do so gently without blocking either nasal passage

INTERVENTIONS ( CONT'D)

• Monitor abdominal signs
• Teach patient to look out for adverse effects such as Shortness of breath, chest discomfort, orthostatic hypotension, cold extremities , paresthesias,visual disturbances
• Teach female patient to report any signs of severe bleed during menstration
• Maintain a quiet environment for adequate rest
• Avoid playing musical instruments that raise pressure inside your head , such as brass instruments

EVALUATION

• Vitals: BP, HR, RR, temp, 02 sat is within normal range
• No signs of bleeding on mucous membranes
• Client gets adequate rest throughout the day
• Platelet count is within normal range (150,000-450,000)
• Bleeding time is within normal range

REFERENCES

• https://www.nhlbi.nih.gov/health/health-topics/topics/ttp
• https://www.pakistantoday.com.pk/2017/10/13/ttp-claims-responsibility-for-k...
• https://www.technologynetworks.com/diagnostics/product-news/ttp-ventus-intr...
• Igvanticus: medical surgical 8th edition