Fundamentals of Nursing Q 229
A nurse is reviewing the complete blood count (CBC) of a child who has been diagnosed with idiopathic thrombocytopenic purpura. Which of the following laboratory results should the nurse report immediately to the physician?
A. Platelet count of 30,000/mm3.
B. Hemoglobin level of 7.5 g/dL.
C. Reticulocyte count of 6.5%.
D. Eosinophil count of 700 cells/mm3.
Correct Answer: B. Hemoglobin level of 7.5 g/dL.
The low hemoglobin level indicates that the client has active bleeding, and immediate actions such as additional diagnostic exams and blood transfusions can be suggested. An initial impression of the severity of ITP is formed by examining the skin and mucous membranes. Widespread petechiae and ecchymoses, oozing from a venipuncture site, gingival bleeding, and hemorrhagic bullae indicate that the patient is at risk for a serious bleeding complication.
Option A: Decreased platelet count is expected in a child with idiopathic thrombocytopenic purpura. Immune thrombocytopenia (ITP) is a syndrome in which platelets become coated with autoantibodies to platelet membrane antigens, resulting in splenic sequestration and phagocytosis by mononuclear macrophages. The resulting shortened life span of platelets in the circulation, together with incomplete compensation by increased platelet production by bone marrow megakaryocytes, results in a decreased number of circulating platelets.
Option C: Increased reticulocyte is expected in a child with idiopathic thrombocytopenic purpura. The measurement of the content of hemoglobin of reticulocytes (CHr or Ret-He) reflects the synthesis of hemoglobin in marrow precursors and allows the detection of early stages of iron deficiency.
Option D: An increased eosinophil count is expected in a child with idiopathic thrombocytopenic purpura. Many authors have reported associations between the increased numbers of eosinophils with platelet dysfunctions, such as increased bleeding time, reduction in platelet aggregation induced by various agonists, among other disorders.