Classroom Care Plan for Students
with Glanzmann's Thrombasthenia (GT)

Students with GT can have a variety of bleeding episodes that can vary in severity. Each GT patient is as unique as the bleeding disorder is rare and the episodes are as random as the next ‘accident’ that is sure to occur at some point. Also, not every episode is brought on by an accident; nosebleeds can be brought on by climate changes; severe changes in temperature (going from hot to cold), becoming overheated, dry air, etc. Spontaneous bruising and bleeding can occur.

Parents of school age GT patients should call a meeting at the beginning of each school year with the child’s teacher, the school nurse, PE teachers, bus drivers, the school principal, and any other personnel with whom the parent or school feels should have basic information about GT and how it affects the child. It is also a good opportunity to reassure everyone that their main responsibility is to call the parent regarding medical issues, rather than trying to fix anything.

BUS
If the child is a bus rider; particularly a younger child, he or she should sit in the front seat in order to allow for communication between the driver and the child without delay. The front seat provides a smoother ride and eliminates horseplay between riders.

PE
GT students can participate in many activities and depending on the age of the student, these activities can vary and can be evaluated based on situational circumstances. GT students should avoid contact sports and ‘rough housing’ activities as a safety precaution. This means NO dodge ball, soccer, baseball, basketball, football, etc. PE activities should be limited to non-contact activities. One elbow or ball to the nose could result in a severe, potentially life-threatening nosebleed. Also, strenuous activities such as running could cause bleeding in the joints. Activities such as tennis, golf, and swimming are great alternatives for GT students and they should be encouraged to participate in these types of sports. Again, age and maturity of the GT student should be taken into consideration. An older GT student can make physical activity decisions for himself.

At the first sign of any pain or discomfort the GT student should elevate and ice the joint that is hurting. Remember the acronym RICE which stands for Rest, Ice Compression (ace or aqua wrap) and Elevation of the affected limb or joint.

RECESS
An assessment of the playground equipment should be made by the GT child’s parents in regards to what is safe and suitable for a GT child to play on. For example, no tether ball or merry go rounds. Also, young children may need to wear a helmet everyday as a precaution against head trauma, particularly if the playground has high slides or other potentially risky equipment.

SCHOOL LUNCHES
No chips, popcorn, hard shell tacos and any other hard or crunchy items should be included in their diet to decrease the occurrence of mouth and gum bleeds. If possible, have the child brush his or her teeth after lunch or rinse out the mouth after lunch to help reduce oral bleeding and good oral hygiene.

FIELD TRIPS
If possible, GT parents should volunteer to chaperone all field trips, especially overnight field trips. GT children may not be able to walk long distances and based on the age of the child, a stroller, a wagon, or even a wheelchair may be required for trips to the zoo, amusement parks, or other venues that require a lot of standing and walking. The GT student should inform his/her teacher at the first sign of pain, at that time a stroller, wagon or wheelchair should be made available for the student.

Snow sledding and skiing are risky activities that GT children should avoid. Horseback riding is to be avoided.

Make sure the GT student wears his or her medic alert bracelet or necklace that day.

If the parent is unable to chaperone the field trip make sure that parent is notified of the location and the activities of the field trip.

FIELD DAY
GT students can participate in many activities and depending on the age of the student, these activities can vary and can be evaluated based on situational circumstances. Sack races, tug of war (unless at the front of the line & wearing gloves), 3 legged races are not suitable activities for a child with a bleeding disorder. Again, age and maturity of the GT student should be taken into consideration. An older GT student can make physical activity decisions for himself.

TREATMENTS
Nosebleeds - keep a nose clamp in the child’s backpack and an extra one in the nurse’s office or school office. This will allow the nose to be pinched while the parent is being notified and on the way to school.

Bruises and joint injuries – RICE which stands for Rest, Ice Compression (ace or aqua wrap) and Elevation of the affected limb or joint.

Parents should be notified of bleeds and injuries that require a trip to the school nurse or office.

Teachers and school personnel are not trained to deal with bleeding or to recognize the degree of severity a GT bleed is. GT children should have a ‘code’ for the severity of their bleed so that the urgency can be relayed to the teachers, nurse, and parent.

#1 – SEVERE, rush me to the nearest doctor or hospital
#2 – BAD, pick me up from school but we can probably take care of the bleed at home or in our doctor’s office
#3 – MODERATE, I can take care of this myself until the end of the school day (scraped knees, slightly oozing nose bleed, gum bleed, painful bruise, etc.)

GT children should be taught to visually inspect their stool and report any bleeding to the teacher who should call the parent immediately.

911
In the event a 911 call needs to be made, make sure it is clear which hospital is to be used and that the EMTs or paramedics are told that the student has a Qualitative Platelet Disorder. The student’s physician’s phone number should be on file at the school and that physician is to be called immediately if the school is unable to contact the student’s parents.