advantage of using one of these drugs in conjunction with prednisolone is that it can lower the prednisolone dose administered , reducing severe side effects ( Foale , 2015 ).
When a patient is on azathioprine , it can cause bone marrow suppression ( Makielski et al ., 2018 ). If this occurs , the patient will be open to further infections and it can lead to the patient becoming neutropenic . If neutropenia is indicated in an IMTP patient then help in reducing any potential acquired infections is important . Introducing antibiotics may help in the control of any developing infection . In addition to this , the patient may also experience vomiting , diarrhoea , inappetence and nausea , so may need adjuvant therapy on top of immunosuppressants to help reduce these side effects . Gastroprotectants and antiemetics such as omeprazole , ondansetron , maropitant and sucralfate will be beneficial in helping to control these side effects .
In most IMTP patients , platelet recovery can usually be seen 1 – 15 days after glucocorticoid treatment . However , if the patient is acutely unwell and at a risk of sudden death , another form of treatment that can be given is vincristine . Vincristine rapidly increases platelet numbers by stimulating platelet release from the bone marrow ; it then stops phagocytosis of platelets and interferes with antibody formation . Vincristine also accelerates the breakdown of megakaryocytes and helps stimulate thrombopoiesis ( Park et al ., 2015 ). In addition , another form of treatment for consideration is human intravenous immunoglobulin ( hIVIG ). hIVIG treatment is when the required component immunoglobulin G ( IgG ) is derived from healthy humans . It can be given to refractory IMTP patients and acts as a strong antiinflammatory . This works by blocking FC receptors on the phagocytic cells and helps stop platelet destruction ( Olivares , 2021 ). However , hIVIG is rarely available as it is in high demand in human hospitals . A study has
Figure 5 . Jugular petechiae . shown that , in refractory IMTP , vincristine should be the first choice for acute management due to its lower cost and ease of administration compared to hIVIG ( Balog et al ., 2013 ).
When considering the range of treatments available to IMTP patients , it is important to remember that treatment could potentially be lifelong and not withdrawn suddenly . Once the patient starts to improve , they are to be continuously monitored and medication doses tapered down accordingly to the lowest level achievable .
Nursing the patient
Nurses play a fundamental role in helping stabilise and manage IMTP patients . This can be a very challenging task as IMTP patients usually stay in for extended periods of time . It is important to consider the patient ’ s accommodation , which will need to be padded ( e . g . a patient mattress with a thick comfortable bed ) due to the risk of localised bruising or bleeding from simple knocks to the body . It is also important the patient is only walked on a harness and not a slip / neck-lead as this could put excess pressure on the neck and cause further bruising and spontaneous bleeds if too much pressure is applied .
IMTP patients have their bloods taken regularly during their stay and it is vital that no jugular samples are obtained , as this is a major vessel . Complications arising from a jugular sample being taken ( Figure 5 ) could be highly detrimental to the patient , due to the inability to safely apply post-sampling pressure to the jugular sufficiently and for long enough . This can lead to haematoma formation and occlusion of breathing . Ideal sampling areas would be from a cephalic or saphenous vein , followed by a pressure bandage . It is imperative that the pressure bandage is not left on for an extended period of time , as this can lead to further bruising and damage .
Intramuscular and subcutaneous injections should also be avoided where possible and medications should be given intravenously or orally . It is essential to note that when giving oral medication to an IMTP patient , it can potentially cause trauma to the mouth , especially in tricky patients . To minimise the trauma caused , medication can be hidden in food or can be continued intravenously , but it is helpful to ensure the patient is eating prior to transitioning to oral medications . This is to ensure that the medication has definitely been ingested , and that it has not led to food aversion . Food aversion should be avoided in an IMTP patient as even everyday tasks could cause their condition to deteriorate . For example , even if usually fed dry food at home , when these patients are in hospital soft food should be offered first , as dry food could damage their gums by causing mucosal bleeding . As the patient already has a low platelet count , this could lead to oral lesions that continue to actively bleed .
26 Veterinary Nursing Journal