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Thrombocytopenia

This document is an evidence-based summary to complement treatment protocols and includes background and rationale for specific point of care actions. It is not intended to be a comprehensive literature review of all available evidence.

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Definition

Thrombocytopenia is reduction in the levels of functional platelets.

Pathophysiology

This reduction may increase the risk of abnormal bleeding resulting in easy bruising and excessive bleeding from wounds or mucous membranes.

Onset/duration

Onset of thrombocytopenia can be within days to weeks of commencing cancer treatment or diagnosis of disease.

Risk factors

Low platelet counts can occur due to disease or can be a side effect of chemotherapy and/or radiation therapy.

Symptoms and signs

  • assess for signs of petechiae, bruising and bleeding
  • monitor for signs and symptoms of anaemia (i.e. fatigue or elevated heart rate).

Investigations and diagnosis

  • monitor full blood count/coagulation
  • monitor vital signs.

Grading

Grade Platelet count
1 less than LLN* - 75 x 109/L
2 less than 75 - 50 x 109/L
3 less than 50 - 25 x 109/L
4 less than 25 x 109/L

* Lower Limit of Normal
Common Terminology Criteria for Adverse Events (CTCAE) v5.0, November 27,2017

Treatment

  • consider platelet transfusion if clinically indicated. Read more about safe platelet transfusion on the Australian Red Cross Blood Service web site.

Educate patient:

  • about signs and symptoms of thrombocytopenia and risk of bleeding
  • to report any signs of bleeding or unusual bruising
  • to minimise risk of injury/bleeding by:
    • using an electric razor
    • wearing gloves and protective shoes in garden
    • using a soft toothbrush
  • to avoid using aspirin and ibuprofen like medications for pain relief
  • to go straight to the Emergency Department or call an ambulance if any of the following develops:
    • rectal bleeding
    • blood in the urine
    • coughing blood
    • vomiting blood
    • nose bleeds.

Version 3

Date Summary of changes
20/09/2010 First approved on eviQ. Version 1.
30/06/2015 Reviewed and reformatted. Version 2.

31/05/2017

Transferred to new eviQ website. Version 3.
24/04/2018 CTCAE information updated to v5.0 published November 27, 2017.
03/08/2023 Document reviewed internally. No changes. Next review in 2 years.

This document reflects what is currently regarded as safe practice. While every effort has been made to ensure the accuracy of the content at the time of publication, the Cancer Institute NSW does not accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work. Any reference throughout the document to specific pharmaceuticals and/or medical products as examples does not imply endorsement of any of these products. While eviQ endeavours to link to reliable sources that provide accurate information, eviQ and the Cancer Institute NSW do not endorse or accept responsibility for the accuracy, currency, reliability or correctness of the content of linked external information source. Use is subject to eviQ’s disclaimer available at www.eviQ.org.au

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The currency of this information is guaranteed only up until the date of printing, for any updates please check:

https://www.eviq.org.au/p/1799

11 Oct 2024