What patient education is given for a patient with thrombocytopenia?

Patient Education for Thrombocytopenia

Patients with thrombocytopenia should be educated to monitor for bleeding symptoms, avoid medications that affect platelet function (aspirin, NSAIDs), limit alcohol intake (≤1 drink/week), and avoid activities with high risk of trauma when platelet counts are below 50 × 10⁹/L. 1

Understanding Thrombocytopenia

• Thrombocytopenia is defined as a platelet count below 150 × 10⁹/L 1, 2

• Severity classifications:

  • Mild: 50-150 × 10⁹/L
  • Moderate: 20-50 × 10⁹/L
  • Severe: <20 × 10⁹/L
  • Very severe: <10 × 10⁹/L 1

• Symptoms correlate with severity:

  • 50 × 10⁹/L: Generally asymptomatic

  • 20-50 × 10⁹/L: May have mild skin manifestations (petechiae, purpura, ecchymosis)
  • <10 × 10⁹/L: High risk of serious bleeding 2

Bleeding Precautions

Activity Restrictions

• Avoid high-risk activities when platelet count is <50 × 10⁹/L:
  • Contact sports
  • Activities with fall risk
  • Activities with risk of trauma 1, 2

Medication Precautions

• Avoid medications affecting platelet function:

  • Aspirin
  • NSAIDs (ibuprofen, naproxen)
  • Some herbal supplements (ginkgo, garlic, ginseng) 1

• Report all medications (including over-the-counter and supplements) to healthcare providers 1

Lifestyle Modifications

• Limit alcohol intake to ≤1 drink/week or consider complete abstinence 1
• Avoid binge drinking completely 1
• Use soft toothbrushes and electric razors to minimize trauma 1
• Maintain good hand hygiene and avoid crowds/sick contacts to prevent infections 1

Monitoring and Follow-up

Bleeding Signs to Watch For

• Instruct patients to report immediately:
  • Prolonged bleeding (>10 minutes) from minor cuts
  • Spontaneous bruising
  • Petechiae (small red/purple spots on skin)
  • Blood in urine or stool
  • Nosebleeds lasting >10 minutes
  • Excessive menstrual bleeding
  • Headaches or visual changes (could indicate intracranial bleeding) 1

Follow-up Schedule

• Regular monitoring is recommended:
  • Every 1-3 months initially
  • Extended to every 3-6 months if stable 1
  • More frequent monitoring may be needed during treatment adjustments 1

Special Situations

Surgical Procedures

• Inform healthcare providers about thrombocytopenia before any procedures
• Different procedures require different minimum platelet counts:
  • Central venous catheter insertion: >20 × 10⁹/L
  • Lumbar puncture: >40-50 × 10⁹/L
  • Major surgery: >50 × 10⁹/L
  • Neurosurgery: >100 × 10⁹/L 1

Pregnancy

• Regular platelet count monitoring is recommended throughout pregnancy
• Mode of delivery should be based on obstetric indications rather than platelet count alone 1

Anticoagulant Use

• Special monitoring may be needed if anticoagulants are required
• Dosing adjustments may be necessary based on platelet count 1

Treatment Expectations

• Treatment depends on the underlying cause and severity of thrombocytopenia
• Platelet transfusions may be needed for severe thrombocytopenia (<10 × 10⁹/L) or active bleeding 2
• For patients receiving romiplostim (Nplate):
  • Weekly injections may be required
  • Regular monitoring of platelet counts is essential
  • Potential side effects include headache, contusion, and upper respiratory infections 3
  • Report any new symptoms promptly to healthcare provider 3

When to Seek Immediate Medical Attention

Instruct patients to seek immediate medical care for:

• Severe headache or altered mental status
• Blood in vomit or stool
• Prolonged or heavy bleeding from any site
• Visual changes or slurred speech
• Fever >38°C (especially if on treatment) 1