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Function of Platelets

Platelets play a critical role in blood coagulation, helping the body form clots to stop bleeding. A normal platelet count ranges between 130,000 and 400,000/mm³. A count below 100,000/mm³ is termed thrombocytopenia. If the count falls below 50,000/mm³, bleeding occurs more easily. A count below 20,000/mm³ carries a risk of spontaneous bleeding.

Causes of Thrombocytopenia

1. Bone marrow suppression caused by chemotherapy or radiation therapy.
2. Direct or indirect bone marrow involvement by the underlying disease or secondary infection.
3. Microvascular lesions caused by end-stage cancer.

Bleeding Symptoms and Care Across 5 Key Anatomical Sites

1. Gastrointestinal Bleeding

• Symptoms: Hematemesis (vomiting blood), melena (black, tarry stools), or hematochezia (bloody stools).
• Eat Soft Foods: Consume bland, soft, non-irritating foods. Eat plenty of vegetables and fruits to prevent hard stools and anal mucosa tearing during bowel movements.
• Maintain Hydration: Drink 2,000–3,000 mL of water daily unless fluid-restricted by a physician.
• Monitor Stools: Observe the color and consistency of daily bowel movements.
• Strict Contraindications: Do not perform enemas or measure rectal temperature.

2. Oral Mucosal Bleeding

• Symptoms: Bleeding gums.
• Maintain Oral Hygiene: Keep the mouth clean and refreshed with frequent gentle rinsing.
• Gentle Brushing: Use an ultra-soft toothbrush or a foam swab. Avoid dental floss.
• Prompt Reporting: Notify nursing staff immediately if gum bleeding occurs.

3. Cutaneous Bleeding

• Symptoms: Petechiae (small red spots on the skin), purpura/ecchymosis (bruising), or delayed wound hemostasis.
• Prevent Trauma: Walk slowly and take precautions to avoid bumps, collisions, or falls.
• Wear Loose Clothing: Choose loose-fitting clothes to minimize skin friction.
• Use Electric Razors: Use electric shavers instead of manual razor blades to prevent accidental cuts.
• Post-Injection Pressure: Apply firm pressure to puncture sites for 5–10 minutes after blood draws or injections.
• Post-Bone Marrow Biopsy Care: Apply local pressure (using a sandbag as clinically indicated) or lie flat for 1–2 hours to promote hemostasis.
• Monitor Skin Changes: Report expanding petechiae or bruising to medical staff immediately.
• Avoid Physical Therapies: Avoid deep tissue massage, acupressure, or gua sha (scraping).

4. Upper Respiratory Tract Bleeding

• Symptoms: Epistaxis (nosebleeds).
• Avoid Nose Picking: Use a damp cotton swab to gently clean nasal mucus or secretions.
• Avoid Forceful Nose Blowing: If necessary, blow gently through both nostrils simultaneously with your mouth open.
• Prevent Dry Mouth: For patients with altered consciousness breathing through an open mouth, place a damp gauze cover over the mouth to prevent airway desiccation and bleeding.

5. Intracranial Bleeding

• Symptoms: Dizziness, headache, altered level of consciousness, severe vomiting, focal weakness, or blurred vision.
• Prevent Straining: Maintain regular daily bowel movements without straining; use stool softeners as prescribed.
• Prevent Coughing: Avoid catching colds, as vigorous coughing increases intracranial pressure and bleeding risks.
• Warning Signs: Immediately notify medical staff if headaches or vomiting worsen.
• Bed Rest: Maintain absolute bed rest when indicated and use a bedpan for bowel movements.
• Gradual Movement: Change positions slowly when getting out of bed using a step-by-step transition (lying $\rightarrow$ sitting $\rightarrow$ standing).