Anemia is a decrease in the number of red blood cells (erythrocytes) in the circulating blood. Without sufficient red blood cells, the circulatory system’s oxygen-carrying capacity is impaired. The patient will usually experience pale skin, muscle weakness, and fatigue. If the amount of oxygen reaching the brain is insufficient, dizziness, depression, irritability, and headache can result; if the amount of oxygen reaching the tissue surrounding the heart is insufficient, angina-like chest pain may result.
The most pervasive symptom is fatigue, and the patient may find that he or she is unable to regain energy and strength even after rest. The section on fatigue gives methods of reducing or coping with this troublesome symptom.
Bleeding Due To Thrombocytopenia
Thrombocytopenia is the decrease in the number of platelets—cells essential to clotting—that circulate in the blood, which may result in bleeding from the skin and mucous membranes, or internally. The decrease may be caused by a failure of the bone marrow to produce mega-karyocyte cells (the precursors of platelets) as a result of radiation therapy or chemotherapy, or for unknown reasons. It may also be caused by abnormal destruction of platelets in the circulating blood by certain forms of cancer, by allergic reaction to specific medications such as quinidine, quinine, digitoxin, sulfonamides, or thiazides, or by physical and emotional stresses that increase the pulse rate and blood pressure, decreasing clot formation and increasing the potential for hemorrhage.
Since protein is essential for megakaryocyte proliferation, the patient should eat protein-rich, high-calorie foods and beverages. Alcohol, which decreases platelet function, should be avoided in all forms (wine, beer, and other types of liquor).
It is most important that patients with thrombocytopenia do everything possible to prevent bleeding. They should:
- Avoid activities with the greatest potential for physical injury.
- Use an electric razor when shaving.
- Use an emery board or fine mesh file for nail care to prevent or repair rough edges.
- Avoid tight-fitting clothing and harsh fabrics, which may irritate the skin.
- Avoid the use of tourniquets.
- Use acetaminophen (e.g., Tylenol or Datril) in place of aspirin, which can exacerbate bleeding problems.
If external bleeding does occur, the patient or a helper should apply pressure to the site for five to ten minutes. If an arm or leg is involved, elevate it above the level of the heart and apply pressure to the bleeding point for a few minutes. If bleeding continues for more than five minutes, the patient should notify his or her physician.
People suffering from thrombocytopenia should not put any excessive pressure on the body. They should avoid strenuous activity, lifting heavy objects, and bending over from the waist. They should also avoid holding the breath while bearing down (known as the Valsalva maneuver) when having a bowel movement, moving up in bed, or in daily activities.
The mucous membranes that line the mouth and the gastrointestinal, upper respiratory, and genitourinary tracts are especially vulnerable to bleeding. Drinking an adequate amount of liquid—at least eight to ten glasses a day—is important to keep skin and mucous membranes from becoming overly dry and to help prevent constipation.
To prevent bleeding of the gums or mouth, the patient should:
- Eat a soft, bland diet and avoid foods that are very hot in flavor or temperature and foods like popcorn or hard pretzels that may irritate the mouth.
- Lubricate the lips with cocoa butter or petroleum jelly.
- Use a soft-bristle toothbrush and a mouthwash with a low alcohol content to cleanse the teeth, gums, and inside of the mouth gently. Avoid ‘••’• using dental floss. If the platelet count is severely depressed, it may be i necessary to clean the teeth with sponge-tipped applicators, gauze y moistened with salt water and wrapped around a finger, or an irrigating syringe.
- Check with the treating physician before having any dental work done.
- Drink an adequate amount of liquid—at least eight to ten glasses a day unless otherwise instructed.
To protect the mucous membranes of the gastrointestinal tract, the patient should:
- Avoid constipation by drinking adequate liquids and getting regular exercise.
- Use stool softeners on a regular basis—daily or as needed.
- Avoid enemas, suppositories, harsh laxatives, and the use of rectal thermometers.
- If on steroids, take them with an antacid or milk to help prevent irritation of the stomach lining. Also, the treating physician’s instructions regarding steroid use should be carefully followed.
- To protect the mucous membranes of the upper respiratory tract, the patient should:
- Avoid forcefully blowing the nose. If it is necessary, the patient should blow gently through both nostrils simultaneously.
- Humidify the room air with a cold-water vaporizer.
- In case of a nosebleed, the patient should apply firm pressure to the nostrils below the bridge of the nose and tilt the head forward. (Tilting the head backward is sometimes advised, but care should be taken to make sure that the bleeding is not in the back of the nostril.) If bleeding 0 does not subside in a few minutes, place ice bags on the bridge of the nose and at the nape of the neck. If bleeding continues for longer than five minutes, the patient should notify a physician.
To protect the mucous membranes of the genitourinary tract, the patient should use a water-based lubricant such as K-Y Jelly prior to sexual intercourse to avoid excessive friction, and should avoid the use of douches and vaginal suppositories.