Books


Bleeding

Introduction

  • decreased platelet counts are the primary cause of bleeding in cancer patients
  • for cancer patients in active treatment, platelet counts drop over 7 to 14 days after treatment ( the nadir is the lowest point reached) and recover within 14 to 18 days
    • - the highest risk for bleeding is at the nadir
  • there is a moderate risk of bleeding when the platelet count is between 20,000 and 50,000 cells/mm3 and the risk is severe when platelets are below 20,000
  • other causes of bleeding in the cancer patient (both in active treatment and not in active treatment) include:
    • infection
    • tumor lysis caused by chemotherapy
    • splenomegaly
    • DIC (disseminated intravascular coagulation)
    • other coagulopathies

Assessment

  • assess the most common bleeding sites including skin and mucus membranes
    • observe for petechiae and ecchymosis, report any signs and symptoms of bleeding to MD
  • ask about signs and symptoms of bleeding including:
    • blood in stool or urine
    • epistaxis and gum bleeding
    • heavy menses
    • headache
  • try to quantify amount, frequency and duration of bleeding

Intervention

Prevention

  • avoid trauma
  • assess safety of home environment
  • stool softeners to prevent straining
  • humidify environment to keep mucus membranes moist
    • use caution with neutropenic patients as the humidified air may promote bacterial growth
  • avoid invasive procedures including IM injections
  • encourage the use of a soft toothbrush, electric razor
  • avoid aspirin-containing products, read labels carefully on over the counter medications

Treatment

  • apply pressure to site of any bleeding or cut
  • platelet transfusions may be required before invasive procedures, otherwise they are not commonly given

References

Haeuber, D. and Spross, J (1994). "Protective Mechanisms: Bone Marrow" in Gross, J. and Johnson, BL (eds) Handbook of Oncology Nursing, 2nd ed., Boston: Jones and Bartlett, p. 373-399.

Gobel, BH. "Bleeding Disorders" in Groenwald, SL, Frogge, MH, Goodman, M, Yarbro, CH, Cancer Nursing: Principles and Practice, 4th ed Boston: Jones and Bartlett, p. 585-603.






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