Patient with platelet count of 3?

[FirstLadyRN]

Quick question. I received a 30 something year old patient with a diagnosis of TTP. Her hemoglobin was within normal limits but her platelets was 3. She was agile and mobile. I would label her a standby assist due to the wires in ICU. As I was giving report to the receiving nurse, she asked me how she voided. I told her on a bedside commode. She scolded me and was upset that I hadn't placed her on strict bedrest.

I understand that a fall in this particular case would be very bad. But she is no more a fall risk than a patient with chest tubes and drains. I mean we are getting patients into chairs who are on ventilators and ECMO. In addition, she had "up ad lib" orders.

I wanted to hear others opinions. What would you do?

[Swellz]

6 hours ago, OncologyCat said:

no bedrest is needed though cause we don’t want them to lose all those muscles either!

Very true!

[Quota, BSN, RN]

8 hours ago, OncologyCat said:

I work Heme/Onc so I’m not surprised about that result. We used to have this pt with ITP and a Plt of 2 his whole life, even after a clinical trial stem cell transplant! He’s so refractory that even after Plt transfusion his plt count actually drops. But anyway, they should be a high fall risk, so yes to stand by assist, and eyes on all the time; no bedrest is needed though cause we don’t want them to lose all those muscles either! We used to have a pt with a plt of 3 that fell in the bathroom and did not tell anyone about it until we found a nice giant bruise on his hip; needless to say it didn’t look good.

I just had an ITP pt last week. Came in at 8 plt, got 1 unit of plt, dexamethasone, and IVIG. Jumped to 16 plt on day 2 and 91 plt on day 3, last dose of dex on day 4 and off to home (I was off that day so don’t know final plt count). At least they had a fast recovery, they have no clue what triggers his ITP flare ups. Clear for all the usual baddies.

[BSN-to-MSN, ADN, BSN, RN]

Nonsense, standby with fall precautions! I work on tele, and 99 percent ICU transfers are bedrest .We get them up and moving! Maybe that nurse worked only in ICU and was not used to mobile patient, Ido. Not to be used as excuse.

[Sweetmemi, BSN, MSN]

In my l&d clinicals, we had a pt in labor with TTP who presented with bleeding. Her platelet count was 6 and was trending downward evem after tx. Unfortunately given the high risk of her labor and risk of receiving blood or bleeding out, she still ended up passing away from complications.

[OncologyCat, BSN, RN]

8 hours ago, Quota said:

I just had an ITP pt last week. Came in at 8 plt, got 1 unit of plt, dexamethasone, and IVIG. Jumped to 16 plt on day 2 and 91 plt on day 3, last dose of dex on day 4 and off to home (I was off that day so don’t know final plt count). At least they had a fast recovery, they have no clue what triggers his ITP flare ups. Clear for all the usual baddies.

Good for him! My pt was so refractory nothing works for him, and we tried all the conventional therapies: plt, IVIG, rituxan, decadron, you name it. That’s why he was enrolled in a clinical trial for a stem cell transplant, but it didn’t work for him either. He’s now in another clinical trial for another stem cell transplant. Poor guy is young too; only in his 20s.

[Quota, BSN, RN]

6 minutes ago, OncologyCat said:

Good for him! My pt was so refractory nothing works for him, and we tried all the conventional therapies: plt, IVIG, rituxan, decadron, you name it. That’s why he was enrolled in a clinical trial for a stem cell transplant, but it didn’t work for him either. He’s now in another clinical trial for another stem cell transplant. Poor guy is young too; only in his 20s.

That’s unfortunate, hope the new trial helps him. My pt is in his early 20s too.

[NewOncNurseRN, BSN, RN]

Oncology nursing and normal lab values! For our patients, platelet count does not determine for our patients if they are up UAL. If blood counts did, none of them would be. What we do is extra education regarding bleeding and falls precautions, encourage patients to get up slowly and call out and wait if they feel dizzy since falls would be pretty terrible etc. For my patient population though, most of the patients have gotten lots of transfusions so they already know the drill.

[PollywogNP, ADN, BSN, MSN, LPN, NP]

23 hours ago, Sweetmemi said:

In my l&d clinicals, we had a pt in labor with TTP who presented with bleeding. Her platelet count was 6 and was trending downward evem after tx. Unfortunately given the high risk of her labor and risk of receiving blood or bleeding out, she still ended up passing away from complications.

23 hours ago, Sweetmemi said:

This sounds more like HELLP syndrome.

[Sweetmemi, BSN, MSN]

On 8/9/2019 at 8:33 PM, PollywogNP said:

This sounds more like HELLP syndrome.

Nope, this pt had TTP for more than 5 years prior to the pregnancy

[guest908299]

On 8/9/2019 at 4:48 PM, NewOncNurseRN said:

Oncology nursing and normal lab values! For our patients, platelet count does not determine for our patients if they are up UAL. If blood counts did, none of them would be. What we do is extra education regarding bleeding and falls precautions, encourage patients to get up slowly and call out and wait if they feel dizzy since falls would be pretty terrible etc. For my patient population though, most of the patients have gotten lots of transfusions so they already know the drill.

Ditto. No need to place this patient on bedrest, just education. After seeing quite a few thrombocytopenic patients develop SDHs or other brain bleeds I definitely take headache complaints fairly seriously.

[PollywogNP, ADN, BSN, MSN, LPN, NP]

On 8/11/2019 at 2:17 AM, Sweetmemi said:

Nope, this pt had TTP for more than 5 years prior to the pregnancy

I had ITP prior to my pregnancy and had HELLP syndrome that was not detected until 2 hours after delivering when they could not get the lady partsl bleeding to stop. My platelet count was 40! And yup LFTs were elevated. Miraculously the bleeding stopped. Both hematologist & oncologists suspect the ITP was precursor to HELLP and to my NHL that developed 17 years later. So, back to your pt that didn’t survive, wonder if it was HELLP that was missed? This happens often.