Platelets counts

Penicillamine (29) can be effective in patients with refractory RA and may delay progression of erosions, but adverse effects limit its useflilness. The most common adverse side effects for penicillamine are similar to those of parenteral gold therapy, ie, pmritic rash, protein uria, leukopenia, and thrombocytopenia. Decreased or altered taste sensation is a relatively common adverse effect for penicillamine. A monthly blood count, platelet count, and urinalysis are recommended, and also hepatic and renal function should be periodically monitored. Penicillamine is teratogenic and should not be used during pregnancy. 

Hematology. The functional status of blood and of the blood-forming tissues can be assessed by tests which include red and white blood cell counts, platelet counts, clotting time, coagulation tests, and examination of bone marrow. Such tests, in addition to detecting abnormahties, may also allow differentiation between primary and secondary effects on blood and blood-forming tissues (75). 

Dactinomycin, an antineoplastic dmg, was discovered in 1943 and is made in rather pure form by StreptomjcesparvuUus. Dactinomycin has some bacteriostatic antibacterial and antifungal activity, but high toxicity limits its use to antineoplastic therapy. It may be used alone or with other antineoplastics, with or without surgery and synergistic x-ray therapy. Dose limiting bone marrow toxicity may result in low white cell and platelet count. Intestinal mucosal damage also occurs. Reviews of more detailed chemotherapeutic information are available (217—222). 

Haematological characteristics (haemoglobin level, red blood and white blood cell counts, platelet count, blood clotting time). 

Thrombopoietic factors (no recombinant TPO product in clinical use at this time IL-11 [recombinant product oprelvekin] has marketing approval) stimulate the production of megakaryocyte precursors, megakaryocytes, and platelets [8]. Interleukin-11 has many effects on multiple tissues, and can interact with IL-3, TPO, and SCF. AMG 531, a recombinant peptibody in that binds to the thrombopoetin receptor Mpl and stimulates the production of platelets, is in phase 1 and 2 studies and has been shown to safely increase platelet counts in patients with immune thrombocytopenic purpura [9]. 

Other adverse reactions associated with penicillin are hematopoietic changes such as anemia, thrombocytopenia (low platelet count), leukopenia (low white blood cell count), and bone marrow depression. When penicillin is given orally, glossitis (inflammation of the tongue), stomatitis (inflammation of die mouth), dry mouth, gastritis, nausea, vomiting, and abdominal pain occur. When penicillin is given intramuscularly (IM), there may be pain at die injection site Irritation of the vein and phlebitis (inflammation of a vein) may occur witii intravenous (IV) administration. 

More than half of the patients receiving this drug by the parenteral route experience some adverse reaction. Severe and sometimes life-threatening reactions include leukopenia (low white blood cell count), hypoglycemia (low blood sugar), thrombocytopenia (low platelet count), and hypotension (low blood pressure). Moderate or less severe reactions include changes in some laboratory tests, such as the serum creatinine and liver function tests. Other adverse reactions include anxiety, headache, hypotension, chills, nausea, and anorexia Aerosol administration may result in fatigue a metallic taste in the mouth, shortness of breath, and anorexia... 

MTX is a potentially toxic dmg that is also used in the treatment of malignancies and psoriasis. Nausea, vomiting, a decreased platelet count, leukopenia (decreased white blood cell count), stomatitis (inflammation of the oral cavity), rash, pruritus, dermatitis, diarrhea, alopecia (loss of hair), and diarrhea may be seen with the administration of this dmg. 

If the platelet count falls below 100,000/mm3 or if the patient experien ces signs and symptoms of thrombocytopen ia (eg, easy bruising, bleeding gums epistaxis melena), the nurse notifiesthephysician immediately. 

Periodic platelet counts, hematocrit, and tests for occult blood in die stool should be performed throughout die entire course of heparin therapy. 

A complete blood count, platelets, and stools for occult blood may be ordered periodically throughout therapy. Thrombocytopenia may occur during heparin administration. A mild, transient thrombocytopenia may occur 2 to 3 days after heparin therapy is begun. This early development of thrombocytopenia tends to resolve itself despite continued tiierapy. The nurse reports a platelet count of less than 100,000 mm3 immediately because die primary care provider may choose to discontinue die heparin therapy. 

Thrombocytopenia is characterized by a decrease in the platelet count (<100,000/mm3). The nurse monitors patients with thrombocytopenia for bleeding tendencies and takes precautions to prevent bleeding. Injections are avoided but, if necessary, the nurse applies pressure to the injection site for 3 to 5 minutes to prevent bleeding into the tissue and the formation of a hematoma The nurse informs the patient to avoid the use of electric razors, nail trimmers, dental floss, firm... 

FAT EMULSIONS. When a fat emulsion is administered, the nurse must monitor the patient s ability to eliminate the infused fat from the circulation. The lipidemia must clear between daily infusions. The nurse monitors for lipidemia through assessing the result of the following laboratory exams hemogram, blood coagulation, liver function tests, plasma lipid profile, and platelet count. The nurse reports an increase in any of these laboratory examinations as abnormal. 

PDElll)-inhibitor that reduees platelet counts... 

Hematological Effects. Leukocytosis and decreased platelet counts were reported in a group of subjects shortly after they ingested an unknown amount of endosulfan (Blanco-Coronado et al. 1992). One subject from that study, who eventually died, had prolonged partial thromboplastin time and prothrombin time with thrombocytopenia, and decreased fibrinogen two days after being admitted to the hospital. Elevated white cell count was also observed in an additional case of fatal acute poisoning with... 

A number of laboratory tests are available to measure the phases of hemostasis described above. The tests include platelet count, bleeding time, activated partial thromboplastin time (aPTT or PTT), prothrombin time (PT), thrombin time (TT), concentration of fibrinogen, fibrin clot stabifity, and measurement of fibrin degradation products. The platelet count quantitates the number of platelets, and the bleeding time is an overall test of platelet function. aPTT is a measure of the intrinsic pathway and PT of the extrinsic pathway. PT is used to measure the effectiveness of oral anticoagulants such as warfarin, and aPTT is used to monitor heparin therapy. The reader is referred to a textbook of hematology for a discussion of these tests. 

Anticoagulant or heparin use <48 h before onset with elevated partial-thromboplastin time Prothrombin time >15 s Platelet count <100,000/mm ... 

Convert to oral warfarin pharmacotherapy once the platelet count has returned to baseline values (preferably >100-150 x 109/L). Continue for at least 30 d in patients without evidence of thrombosis (optimal duration is not known but one author recommends at least 2-3 mo of warfarin Blood, 2003). Continue for at least 6 mo in patients with evidence... 

Aspirin Dyspepsia, bleeding, gastritis Clinical signs of bleeding,3 gastrointestinal upset baseline CBC and platelet count CBC platelet count every 6 months... 

Unfractionated heparin Bleeding, heparin-induced thrombocytopenia Clinical signs of bleeding3 baseline CBC and platelet count aPTT every 6 hours until target then every 24 hours daily CBC platelet count every 2 days (minimum, preferably every day)... 

Warfarin Bleeding, skin necrosis Clinical signs of bleeding3 baseline CBC and platelet count CBC and platelet count every 6 months following hospital discharge baseline aPTT and INR daily INR until two consecutive INRs are within the target range then once weekly x 2 weeks, then every month... 

Heparin-induced thrombocytopenia (HIT) is a very serious adverse effect associated with UFH use. Platelet counts should be monitored every 2 to 3 days dining the course of UFH therapy.5 HIT should be suspected if the platelet count drops by more than 50% from baseline or to below 120,000. In patients with contraindications to anticoagulation therapy, UFH should not be administered (Table 7-7). 

Hemophilia or other hemorrhagic tendencies Severe liver disease with elevated baseline PT Severe thrombocytopenia (platelet count less than 20,000) Malignant hypertension... 

The incidence of HIT is lower with LMWHs than with UFH. However, LMWHs cross-react with heparin antibodies in vitro and should not be given as an alternative anticoagulant in patients with a diagnosis or history of HIT.5 Monitor platelet counts every few days during the first 2 weeks and periodically thereafter.5... 

Measure PT/INR every 2 to 3 days. Obtain CBC or platelet count. 

If the patient is treated with UFH or LMWH and platelet count has dropped by more than 50% from baseline or is less than 120x1 OVjil, evaluate the patient for heparin-induced thrombocytopenia (HIT). 

Known bleeding diathesis, including but not limited to (1) platelet count less than 100 x 1 0 /mm3 (100 x 109/L) (2) heparin within 48 hours with an elevated aPTT or (3) current oral anticoagulant use (e.g., warfarin) or recent use with an elevated PT (greater than... 

Carbamazepine Manufacturer recommends CBC and platelets (and possibly reticulocyte counts and serum iron) at baseline, and that subsequent monitoring be individualized by the clinician (e.g., CBC, platelet counts, and liver function tests every 2 weeks during the first 2 months of treatment, then every 3 months if normal). Monitor more closely if patient exhibits hematologic or hepatic abnormalities or if the patient is receiving a myelotoxic drug discontinue if platelets are less than 100,000/mm3, if white blood cell (WBC) count is less than 3,000/mm3 or if there is evidence of bone marrow suppression or liver dysfunction. Serum electrolyte levels should be monitored in the elderly or those at risk for hyponatremia. Carbamazepine interferes with some pregnancy tests. 

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