TTP

yesterday i cared for a 45 year old woman newly diagnosed with TTP - thrombotic thrombocytopenic purpura.  say that 12 times fast!  it's a clotting disorder thats onset is rather sudden and if left untreated causes death - rather rapidly.  micro-clots form in the blood stream raising havoc in the kidneys, heart, and brain (just a few of the vital organs!).

the most successful treatment of this disorder is called plasmapheresis (seriously, why is everything in medicine so hard to pronounce?).  anyhoo, what it entails is a dialysis-like machine.  yesterday, my patient had 4L of plasma "exchanged."  that's FOUR LITERS of donated plasma exchanged with her crappy plasma.  it's quite the ordeal.  it requires a fancy kind of line (intravenous access).  and takes multiple hours.  any time the body loses or exchanges liters of fluid (as in dialysis or plasmapheresis), blood pressure is critical and susceptible.  hers was decent, but on the low end of normal all day.

so when a nursing assistant found me and told me my patient decided to leave the unit alone to get a latte, i was a bit worried.  my patients are not allowed to leave our floor.  with a hematocrit of 22 (seriously low) and a platelet count of 10 (crazy low), she is at a huge risk for a fall with potential for a lethal outcome.  no joke.  a fall with a platelet count of 10 could cause a serious brain bleed (just read the post from last week to know what i'm talking about).

i decided the damage was done.  the nursing assistant had told her not to leave.  but she did anyway.  she's an adult and can make her own decisions.

but i really became worried when the secretary called me and told me to get down to the cafeteria STAT with a wheelchair.  my patient was dizzy, about to fall, and nauseated.  apparently some physicians were at her side, waiting for my arrival.

it was quite the scene i arrived at.  my patient was surrounded by not one but three physicians.  there were orange juice containers and sugar packets strewn about (i guess they assumed she was diabetic and had low blood sugar; quite the contrary... when i brought her back upstairs, her blood sugar was sky high thanks to their "help").  and one of the physicians was trying to check a blood pressure.  i kid you not, she seriously said out loud, "i forget how to check a blood pressure."  when i offered to do it for her, i got no response.  now that i think of it, they didn't really talk to me at all.

i thanked the physicians for their "help" and returned my patient to my unit safe and sound.