Differential Diagnosis for Physical Therapy: Hematological, Cardiovascular, Immune, and Digestive System Disorders: Summary 118
Platelet Disorders Thrombocytosis Count of more than 1 million platelets per microliter • Usually temporary • Compensatory mechanism after severe bleeding, surgery, splenectomy, iron deficiency, or occult neoplasm • Clients have a tendency to bleed or clot (impaired production of thromboplastin) Thrombocytopenia Decrease in count (less than 150,000/mm 3 ) resulting from defective platelet production or accelerated platelet destruction • Major concern is the prevention of excessive bleeding that occurs from trauma to mucous membranes • Causes: bone marrow infiltration (malignancy), viral infections, prosthetic heart valves, nutritional deficiency (folic acid/vitamin B12), drugs, hemorrhage, disseminated intravascular coagulation (DIC): excessive bleeding and clotting (petechiae), hypersplenism • Symptoms: easy or excessive bruising (purpura), superficial bleeding into the skin that appears as a rash of pinpoint- sized reddish-purple spots (petechiae), prolonged bleeding from cuts, bleeding from gums or nose, blood in urine or stools Coagulation Disorders Hemophilia Hereditary blood-clotting disorder due to abnormal plasma proteins (factors VIII and IX), 80% of hemophiliacs, transmitted by X-linked recessive trait, and manifested in men but carried by women Hemophilia B 30% of cases, no family history of the disorder, and the condition is the result of a spontaneous gene mutation bleed longer, not faster Hemophilia A (classic)
• Clients with polycythemia have increased whole blood volume/viscosity ○ Increased tendency toward clotting ○ Diminished blood to brain and other tissues due to high viscosity Leukocytic Disorders Leukocytosis Count of 10,000 WBCs/mm 3 • Bacterial infections • Inflammation/tissue necrosis • Metabolic • Neoplasms • Acute hemorrhage • Splenectomy • Acute appendicitis • Pneumonia • Chemical intoxication Leukopenia Reduction in number of leukocytes (<4,800/mm 3 ) • Bone marrow failure due to chemotherapy/radiation therapy • Overwhelming infections • Dietary deficiencies • Autoimmune diseases
LEARNING TIP! Mild reduction in WBCs can be caused by viral infection.
• If client is immunosuppressed, physical therapist must know most recent WBC count prior to therapy session • Symptoms: Infections, fatigue, sleepiness, fever, and headache Nadir Lowest point in WBC count; occurs 7–14
days after chemo/radiation therapy • Client is extremely susceptible to
opportunistic infections/complications; hand washing and hygiene extremely important in treating these clients
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