Platelet Disorders Thrombocytopenia

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Thrombocytopenia is a condition that occurs when the platelet count in your blood is too low. Platelets are tiny blood cells that are made in the bone marrow from larger cells. When you are injured, platelets stick together to form a plug to seal your wound. This plug is called a blood clot. Platelets are also called thrombocytes, because a blood clot is also called a thrombus.

A normal platelet count in adults ranges from 150,000 to 450,000 platelets per microliter of blood. A platelet count of less than 150,000 platelets per microliter is lower than normal. When you have a low platelet count, you may have trouble stopping bleeding. Bleeding can happen inside your body, underneath your skin, or from the surface of your skin. You may not have serious bleeding until your platelet count is very low.

Thrombocytopenia can be life-threatening, especially if you have serious bleeding or bleeding in your brain. Early treatment can help you avoid serious complications.

Bleeding causes the main symptoms of thrombocytopenia. Symptoms can appear suddenly or over time. Mild thrombocytopenia often has no symptoms. Many times, it is found during a routine blood test.

Signs of bleeding may include:

• Bleeding that lasts a long time, even from small injuries
• Petechiae, which are small, flat red spots under the skin caused by blood leaking from blood vessels
• Purpura, which is bleeding in your skin that can cause red, purple, or brownish- yellow spots
• Nosebleeds or bleeding from your gums
• Blood in your urine or stool, which can appear as red blood or as a dark, tarry color
• Heavy menstrual bleeding

To diagnose thrombocytopenia, your provider will ask about your medical and family history. They will also ask about your symptoms and do a physical exam to look for signs of bleeding.

Your provider may order one or more of the following blood tests:

• Complete blood count (CBC): This test measures the levels of platelets and other blood cells in your blood.
• Blood smear: For this test, some of your blood is put on a slide. A microscope is used to look at your platelets.
• Bone marrow tests: These tests check whether your bone marrow is healthy.

Thrombocytopenia can be inherited or acquired. “Inherited” means your parents pass the gene for the condition to you. “Acquired” means you are not born with the condition, but you develop it later. Sometimes the cause of thrombocytopenia is not known.

You may have a low platelet count for the following reasons.

• Your body’s bone marrow does not make enough platelets.
• Your bone marrow makes enough platelets, but your body destroys them or uses them up.
• Your spleen holds on to too many platelets. The spleen is an organ in your abdomen. It normally stores about one-third of the body’s platelets. It also helps your body fight infection.

The following factors can raise your risk of thrombocytopenia.

• Environment: Exposure to toxic chemicals — such as pesticides, arsenic, and benzene — can slow the production of platelets.
• Lifestyle habits: Alcohol slows the production of platelets. Drinking too much alcohol can cause your platelet count to drop for a short time. This is more common in people who have low levels of vitamin B12, or folate.
• Medicines: Some medicines can slow the production of platelets. Also, a reaction to medicine can confuse your body and cause it to destroy its platelets.

• Other medical conditions: Examples of health problems that can reduce your platelet count are listed below.
  • Aplastic anemia is a rare, serious blood disorder that develops when the bone marrow stops making enough new blood cells.
  • Autoimmune diseases, such as immune thrombocytopenia (ITP), lupus, and rheumatoid arthritis can cause your immune system to attack and destroy your platelets by mistake.
  • Cancer, such as leukemia or lymphoma, can damage your bone marrow and destroy blood stem cells. When stem cells are damaged, they do not grow into healthy blood cells. Cancer treatments, such as radiation and chemotherapy, also destroy the stem cells.
  • Conditions that cause blood clots, such as thrombotic thrombocytopenic purpura (TTP) and disseminated intravascular coagulation (DIC), can cause your body to use up all your platelets. This leads to a low platelet count.
  • Infections from bacteria and viruses can lower your platelet count for a while.
  • A spleen that is larger than normal may remove or store too many platelets, and you may not have enough platelets in your blood.
• Pregnancy: Some pregnant women develop mild thrombocytopenia when they are close to delivery. The exact cause is not known. Learn more about low platelet counts during pregnancy.
• Surgery: Platelets can be destroyed when they pass through artificial heart valves, blood vessel grafts, or machines and tubing used for blood transfusions or bypass surgery.

Treatment for thrombocytopenia depends on what caused it and whether you have any symptoms. If you have mild thrombocytopenia, you may not need treatment. A fully normal platelet count is not necessary to prevent serious bleeding, even with serious cuts or accidents.

If you have serious bleeding or a high risk of complications, you may need medicines or procedures. Also, you will need to treat the condition that is causing the low platelet count.

If a reaction to a medicine is causing the low platelet count, your provider may prescribe another medicine. Most people recover after the initial medicine has been stopped. For HIT, stopping the heparin is not enough. Often, you will need another medicine to prevent blood clotting.

If your immune system is causing the low platelet count, your provider may prescribe medicines to suppress the immune system.

Medicines

Corticosteroids, such as prednisone, are commonly used to treat a low platelet count. These medicines, called steroids for short, help increase your platelet count.

You may need medicines such as eltrombopag and romiplostim to help your body make more platelets. Medicines such as immunoglobulins and rituximab can help stop your immune system from destroying your platelets.

Procedures

If medicines do not work, you may need one of the following procedures.

• Blood or platelet transfusions are used to treat people who are bleeding heavily or are at a high risk of bleeding. During this procedure, a needle is used to insert an intravenous (IV) line into one of your blood vessels. Through this line, you receive healthy blood or platelets. If you have HIT, a platelet transfusion can raise your risk of blood clots. Learn more about blood transfusions.  
• Surgery to remove your spleen (splenectomy) can help increase the platelet count in your blood. Your spleen stores platelets. Possible complications include bleeding, infection, and abnormal blood clots.

Without proper treatment, thrombocytopenia can cause serious bleeding. This can happen both inside your body and out of your skin. It can be life-threatening. Learn how you can manage thrombocytopenia to help prevent complications.