Physical Therapy Intervention for an Individual With Severe Thrombocytopenia

Abstract

Introduction: Individuals can develop refractoriness to platelet transfusions, defined as a platelet count that does not rise after transfusion. This report describes the complex physical mobility needs of an individual who incurred platelet refractoriness and physical deconditioning after undergoing a hematopoietic stem cell transplant (HSCT). Case Description: A 47-year-old man with a diagnosis of myelodysplastic syndrome was admitted to an inpatient hospital setting and underwent an allogenic HSCT. After the transplant, he developed thrombocytopenia refractory to platelet transfusion with accompanying physical deconditioning. At the time of the physical therapy evaluation, the patient required moderate assistance for transfers and moderate assistance to ambulate 2 ft. Intervention: Over the course of 8 physical therapy sessions, the patient's platelet count ranged from 1000/μL to 6000/μL. The sessions focused on functional mobility with modifications to reduce joint and muscle strain. Results: No bleeding events occurred as a result of the physical therapy intervention. Following the 8 physical therapy sessions, the patient was able to ambulate 150 ft, ascend/descend several stairs, and complete the 5-time sit-to-stand test in 18.9 seconds. The patient's 6-Clicks score improved from 12 (60%-79% functional impairment) to 24 (0% functional impairment). Discussion: Despite severe thrombocytopenia, the patient made significant improvements in mobility. It is critical for therapists to consider the entire clinical situation when weighing the risk and benefits of mobilizing individuals with chronic thrombocytopenia.