Plus-Hex CLINICAL
to produce melaena , the chances of survival reduce to 60 % ( Gorman , 2011 ). IMTP patients can be one of the most challenging but also rewarding cases to nurse . There is a lot that veterinary nurses can do to help keep the patient comfortable while reducing their injury risks in hospital . It is imperative to alert other staff members to what can and cannot be done with the patient during their stay , so their injury risk is reduced and they have more chance of recovering from this lifethreatening condition .
REFERENCES
Figure 6 . Haematuria .
Feeding tubes in IMTP patients are usually avoided as existing trials have not evaluated the feasibility of either nasogastric or oesophageal tubes being placed – due to the contraindication of bleeding complications ( Patel et al ., 2016 ).
As a whole , it is important to handle IMTP patients very gently in all aspects of treatment and care , due to their risk of haemorrhage following the slightest bump or knock , which could cause them to have a spontaneous bleed . The patient ’ s vitals , such as heart rate and respiratory rate , should be monitored frequently . Documenting and monitoring the areas of localised bruising and petechiae on the patient should also be carried out , in order to monitor deterioration . This can be achieved either by carefully clipping the areas of bruising and marking with a pen , or by taking daily pictures . As the patient will be on a high dose of steroids , it is important to ensure they have free access to water and are able to reach this themselves . If not , offering them water frequently should be added to their hospital sheet . As the patient will be drinking more , they will need to toilet frequently so regular walks are necessary , along with absorbent bedding to reduce the risk of urine scalding . When walking , it is important to check their urine and note any abnormalities that may be present , such as haematuria ( Figure 6 ) or pigmenturia . A urine sample for laboratory testing and monitoring may also need to be collected . Another nursing consideration would be wearing appropriate personal protective equipment ( PPE ) when handling the patient , such as gloves and an apron , because they are likely to be on immunosuppressant treatment and will need reverse barrier nursing for their own protection . If the patient has received cytotoxic treatment then a fulllength apron and purple nitrile gloves will be sufficient .
Conclusion
Balog , K ., Huang , A . A ., Sum , S . O ., et al . ( 2013 ) A prospective randomized clinical trial of vincristine versus human intravenous immunoglobulin for acute adjunctive management of presumptive primary immune-mediated thrombocytopenia in dogs . Journal of Veterinary Internal Medicine . 27 ( 3 ), 536 – 541 .
Brooks , W . ( 2003 ) Immune-mediated thrombocytopenia ( IMT ). Available from : https :// veterinarypartner . vin . com / default . aspx ? pid = 19239 & id = 4951884 . [ Accessed 2 February 2021 ].
BluePearl Specialists . ( 2021 ) Immune-mediated diseases : thrombocytopenia & hemolytic anemia . Available from : https :// bluepearlvet . com / medicalarticles-for-pet-owners / immune-mediated-thrombocytopenia-andhemolytic-anemia-in-dogs /. [ Accessed 8 February 2021 ].
Donoghue , E . ( 2019 ) Immune-mediated thrombocytopenia . Available from : http :// vhc . missouri . edu / small-animal-hospital / small-animalinternal-medicine / diseases-and-treatments / immune-mediatedthrombocytopenia /. [ Accessed 2 February 2021 ].
Foale , R . ( 2015 ) How should we medicate canine immune-mediated thrombocytopaenia ? In : BSAVA Congress Proceedings 2015 , 9 – 12 April 2015 , Birmingham , UK . Gloucester , BSAVA . pp . 225 – 226 .
Gorman , L . ( 2021 ) Immune-mediated thrombocytopenia ( ITP ) in Dogs . Available from : https :// www . mspca . org / angell _ services / immune-mediatedthrombocytopenia-itp-in-dogs /. [ Accessed 10 February 2021 ].
Herrtage , M ., Warland , J ., Kent , A . & Bazelle , J . ( 2020 ) Immune-mediated thrombocytopenia ( ITP ) in dogs . Available from : https :// www . itpsupport . org . uk / index . php / en / itp-in-dogs . [ Accessed 16 February 2021 ].
LaPelusa , A . & Dave , H . ( 2020 ) Physiology , hemostasis . Available from : https :// www . ncbi . nlm . nih . gov / books / NBK545263 . [ Accessed 2 February 2021 ].
Lo , E . & Deane , S . ( 2014 ) Diagnosis and classification of immune-mediated thrombocytopenia . Autoimmunity Reviews . 13 ( 4-5 ), 577 – 583 .
Makielski , K ., Brooks , M ., Wang , C ., Cullen , J ., O ’ Connor , A . & LeVine , D . ( 2018 ) Development and implementation of a novel immunethrombocytopenia bleeding score for dogs . Journal of Veterinary Internal Medicine . 32 ( 3 ), 1041 – 1050 .
Olivares , G . ( 2021 ) Immunemediated thrombocytopaenia and other platelet disorders presentation . [ Accessed 17 March 2021 ].
Park , H . J ., Kim , J . W ., Song , K . H . & Seo , K . W . ( 2015 ) Application of vincristineloaded platelet therapy in three dogs with refractory immune-mediated thrombocytopenia . Journal of Veterinary Science . 16 ( 1 ), 127 – 130 .
Pullen , R . ( 2015 ) What are immunoglobulins ? Nursing Made Incredibly Easy . 13 ( 2 ), 20 – 23 . Available from : https :// journals . lww . com / nursingmadeincrediblyeasy / Citation / 2015 / 03000 / What _ are _ immunoglobulins _. 6 . aspx . [ Accessed 1 February 2021 ].
Patel , R . T ., Canada , T . W . & Nates , J . L . ( 2016 ). Bleeding associated with feeding tube placement in critically ill oncology patients with thrombocytopenia . Nutrition in Clinical Practice . 31 ( 1 ), 111 – 115 .
Sellon , R . K . ( 2011 ) Diagnosis and treatment of immune-mediated thrombocytopenia ( Proceedings ). Available from : https :// www . dvm360 . com / view / diagnosis-and-treatment-immune-mediated-thrombocytopeniaproceedings . [ Accessed 8 February 2021 .]
Walton , J . & Tappin , S . ( 2021 ) Red blood cell transfusions – when , what and how to do it ! VETcpd - Internal Medicine . 4 ( 4 ), 29 – 34 .
Overall , it is found that dogs diagnosed with IMTP can have a good recovery rate of around 75 – 85 % if caught early and treated accordingly . However , studies have shown that when the patient develops and starts
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