•Clinical signs: appearance of petechiae (small, red, punctual skin or mucous membrane bleedings, which do not blanch with pressure), hematoma (purple hemorrhages under the skin)

•Bleeding of mucous membranes, nose bleeds

•Bloody stools or urine

Prophylactic Care

•Avoidance of activities with potential of serious injury for the child

•No intramuscular or subcutaneous injections

•No sports activities with potential for injury

•No drugs with antiplatelet properties, for example, Aspirin

•Caution when cutting and filing nails

•Avoidance of tight clothes

•Clean nose carefully; if necessary humidify air (but take care: higher risk of fungal infection), nose cream

•No enemas, suppositories, or rectal temperature measurements

•No intake of specially hard (e.g., bread crust), hot, or spicy food

•In case of constipation, use of laxatives

•Keep lips soft

•Use of soft tooth brush; no dental floss

Treatment

•Transfusion of platelets according to medical instructions

•Single-donor platelet transfusion for patients who are sensitized to various HLA antigens

•Platelet concentrates contain few leukocytes, which are mostly removed through a leukocyte filter

•Effectiveness of platelet transfusions: determination of platelet count after 1 h and 24 h

•Should platelet count fall rapidly after reaching a high or expected level, this indicates an increased consumption of platelets, such as in the case of sepsis or disseminated intravascular coagulation. The initial rise after transfusion may be due to host antiplatelet antibodies

•Transfusion reactions are: chilling, fever, agitation, anxiety, shortness of breath, headache, joint pain, aches, nausea, vomiting, urticaria, redness of skin, rising temperature, fall in blood pressure, signs of shock, oliguria

•Further measures: in case of large hematoma, cold packs may be of help, pressure bandage for bleeding wounds; for nose bleeds, sit in an upright position, cold packs on the neck or on the bridge of the nose, and press wings (alae nasi) of nose against nasal septum

19.2.4.4Anemia

Symptoms

•Dependent on extent of anemia and general condition of patient

•General symptoms: performance decline, fatigue, dyspnea, tachycardia, palpitations, dizziness, headache, rapid pulse, difficulty concentrating