What action should the nurse take for a client with severe thrombocytopenia?

Management of Severe Thrombocytopenia (9,800/mm³)

The nurse should immediately refer the client with a platelet count of 9,800/mm³ to the emergency department, as this represents severe thrombocytopenia with high risk of serious bleeding. 1, 2

Initial Assessment and Actions

• Recognize that a platelet count below 10,000/mm³ represents severe thrombocytopenia with high risk of serious bleeding and requires immediate intervention 1
• Immediately refer the client to the emergency department as recommended for patients who are acutely unwell with thrombocytopenia of any severity 3
• Assess for signs of active bleeding (petechiae, purpura, ecchymosis, mucous membrane bleeding) as these would further increase the urgency of intervention 1
• Monitor vital signs closely while arranging transfer to emergency care 2

Hospital Management Considerations

• Hospitalization is appropriate for patients with platelet counts <20,000/mm³, especially those with significant mucous membrane bleeding 4
• The emergency department will likely initiate the following interventions:
  • Platelet transfusion to rapidly increase platelet count, especially if there is active bleeding 4, 1
  • Intravenous immunoglobulin (IVIg) administration (1 g/kg) if immune-mediated thrombocytopenia is suspected 4
  • High-dose parenteral glucocorticoid therapy may be initiated for severe thrombocytopenia 4, 5

Diagnostic Considerations

• The emergency department will perform additional testing to determine the cause of thrombocytopenia, including:
  • Complete blood count with peripheral blood smear to confirm true thrombocytopenia and rule out pseudothrombocytopenia 1, 6
  • Coagulation studies including D-dimer measurement 4
  • Additional testing based on clinical presentation to identify potential causes such as drug-induced thrombocytopenia, immune thrombocytopenia, or thrombotic microangiopathies 1, 6

Important Precautions

• Avoid invasive procedures until platelet count is increased 1
• Implement bleeding precautions including:
  • Minimize venipunctures and use smallest gauge needle possible 7
  • Apply prolonged pressure to venipuncture sites 1
  • Avoid intramuscular injections 7
  • Maintain activity restrictions to prevent trauma-associated bleeding 1

Pitfalls to Avoid

• Delaying referral to emergency care - severe thrombocytopenia (platelet count <10,000/mm³) requires immediate medical attention 3, 1
• Failing to recognize that severe thrombocytopenia can be life-threatening even without visible bleeding 1
• Missing potential causes that require specific interventions (e.g., drug-induced thrombocytopenia, heparin-induced thrombocytopenia, or thrombotic microangiopathies) 7
• Administering medications that affect platelet function (e.g., NSAIDs, aspirin) which could worsen bleeding risk 1