preventing and managing bleeding in a patient with low platelets is a challenge to healthcare providers, Bleeding is one of the major complications during chemotherapy treatment. It could be fatal in case of a severe emergency. Chemotherapy besides destroying cancer cells also kills and damages normal blood cells. As a result, the patient has a lower number of platelets and hemoglobin. This puts a patient at a higher risk of bleeding.
What is the function of platelets?
Platelets are the main component of blood in our body. Their function is to stop bleeding. Whenever there is any internal or external tissue trauma platelets aggregate together to form clots and attach to the site of injury, which results in decreasing or stopping bleeding.
Types of bleeding 🙁 from where a patient could bleed)
Gum bleeding:
Avoid brushing teeth: brushing teeth with a hard toothbrush can put you at greater risk for gum bleeding which further can be a risk for infection
Nose bleeding:
Avoid cleaning the nose and blowing This could cause nose bleed. Also, keep the nose and lips moist by applying Vaseline gently.
Intracranial bleeding 🙁 bleeding in the brain)
A person is at greater risk of intracranial bleeding if had a history of seizures/fits and hypertension (high blood pressure).In case of a lower number of platelets, such patients should be treated as high-risk patients and their blood pressure and seizures should be managed immediately. Blood pressure should be monitored frequently and medication should be started as soon as possible, and for fits and seizures, medication should be given or started as a preventive measure.
Bleeding from the vagina: Preventing and managing bleeding after chemotherapy:
Vaginal bleeding could be prevented by stopping the menstrual cycle of fertile females with some special medications containing some hormones.
Monthly period bleeding may be worsening if it starts with a low platelet count. This further lowers the level of hemoglobin. The patient may need a transfusion of a pack of red cells in case of very low hemoglobin levels.
Bleeding from stomach/small intestine:
A black stool is a sign of bleeding from the stomach and small intestines. In case of one or two episodes of black stools must consult your health care provider. The reason behind the black color stools is, that when stools are mixed up with acid in the stomach and small intestine it turns into black color. The patient will have pain in the upper part of the abdomen, especially in the gastric region.
Bleeding from the lower abdominal region:
If the patient bleeds from the lower abdomen or intestine its color will be red. Furthermore, a patient will be having pain in the lower abdominal region.
How to prevent and control bleeding? 🙁 prevent from complications)
Bleeding can be prevented by taking some precautions.
Keep the platelets range above a certain level by monitoring the complete blood count daily, especially after the first week of the chemotherapy cycle.
Notice some warning signs:(prevent bleeding)
Noticing some warning signs before bleeding such as severe headache, severe epigastric pain, bruises on the skin, high blood pressure, and blurry vision, managing these symptoms on time can prevent bleeding.
Following are also some preventative measures:
Avoid using sharp razors on the skin. (Preventing and managing bleeding after chemotherapy)
Using a sharp razor can cause a cut and damage to the skin that can lead to bleeding which may be difficult to control with low platelet count. Furthermore, avoid using sharp knives or scissors at home. Trim nails carefully if needed.
Avoid using NSAIDS: (Non -steroidal anti-inflammatory drugs):
These medications are used as over-the-counter drugs which are easily available in medical stores and can be sold out without a physician’s prescription. So, laymen (a person who is not familiar with medicine or medical terminologies) must explain the patient’s condition before purchasing the medication and administrating it to patients having low platelets or other special conditions.
These drugs put a person at risk of bleeding so, Using these drugs with a lower platelet count should be avoided to prevent bleeding. So, avoid using these drugs while on chemotherapy treatment.
Avoid strenuous exercises:
Do not do strenuous exercises such as gymnastics or push-ups etc. These types of exercises can be dangerous with low platelet count. Furthermore, avoid strong sun exposure in hot weather it causes the blood vessels to dilate which further causes bleeding.
No intramuscular injections:
Do not inject any drug intramuscularly this may cause bleeding under the skin and hematomas(accumulation of blood under the skin) which further can be a cause of infections in immunocompromised patients. sometimes needs to cut the skin to drain the accumulation.
Avoid sexual contact with your partner:
Having sex with low platelets can cause vaginal bleeding which could be uncontrollable in case of tissue trauma.
Healthcare professionals should avoid procedures such as Foleys catheterization, nasogastric tube insertion, avoid needle pricks, and some physical examinations such as vaginal examination and Direct Rectal examinations known as DRE, Such minor procedures can put a patient at a greater risk of bleeding in a patient with low platelets count.
Bleeding from the urinary bladder:
Bleeding from the urinary bladder is another major complication with low platelets. Besides low platelets some chemotherapeutic medications irritate the urinary bladder walls and cause bleeding. Chemotherapy-induced bleeding or hemorrhagic cystitis. The important thing with such chemotherapeutic medication maintaining well hydration of the patient. Such chemotherapeutic medications are always given with their antidotes. Moreover, do not forget to instruct the patient to pass urine again and again and not hold the urine.
What are the special precautions for bleeding from the urinary bladder?
If a patient has bleeding from the urinary bladder it is recommended to not take medication to stop bleeding. Medication usually used to stop bleeding causes blood clotting. If blood clots are formed in the urinary bladder it causes a urinary pathway obstruction that further becomes a surgical emergency. For its management, a hole in the suprapubic region is made and the clot is removed through it. so be careful in managing a patient with hematuria (blood in urine). Moreover, the most important thing in managing a patient with a bleeding urinary bladder is hydration. By hydrating patient will pee urine again and again and the blood will not form clots in the bladder. If the bleeding is severe a three-way urinary catheter is recommended to irrigate or wash the bladder. This again cleans the inner walls of the bladder.
So, platelets play an important role in stopping bleeding in our bodies. Some preventive measures such as controlling blood pressure maintaining hydration, and avoiding unnecessary medications can lower the risk of bleeding. Moreover, special care should be taken while handling a patient with a low platelet count. Healthcare providers must be alert about the symptoms while taking care of a patient with a low platelet count.
