Platelet Disorders Thrombocytopenia

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Thrombocytopenia is a condition that develops when the platelet count in your blood is too low. When you are injured, platelets (tiny blood cells) stick together to form a plug, called a blood clot, that seals your wound. 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 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 on 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 under 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: 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 has too many platelets. The spleen is an organ in your abdomen that helps your body fight infection. It normally stores about one-third of the body's platelets.

In immune thrombocytopenia (ITP), your immune system attacks and destroys your body's platelets by mistake.

• Environment: Exposure to toxic chemicals — such as pesticides, arsenic, and benzene — can damage your bone marrow. As a result, it cannot make platelets fast enough.
• Lifestyle habits: Alcohol can damage your bone marrow and cause it to make fewer platelets than normal. This is more common in people who have low levels of vitamin B12 or folate.
• Medicines: Some medicines can affect your body's ability to make platelets. Also, an immune reaction to a medicine can confuse your body and cause it to destroy 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 bone marrow stops making enough new platelets and other blood cells.
  • Autoimmune diseases can cause your immune system to attack and destroy your platelets by mistake. These diseases include lupus and rheumatoid arthritis, in addition to ITP.
  • Immunodeficiencies: Oddly, disorders with low immune function (like CVID) may be associated with ITP.
  • Cancer, such as leukemia or lymphoma, can damage your bone marrow and destroy the stem cells that develop into platelets. When stem cells are damaged, they do not grow into healthy platelets. Cancer treatments, such as radiation and chemotherapy, also destroy the stem cells.
  • Conditions that cause blood clots can cause your body to use up all your platelets. This leads to a low platelet count. These conditions include thrombotic thrombocytopenic purpura (TTP) and disseminated intravascular coagulation.
  • Infections from bacteria and viruses can lower your platelet count for a period.
  • A spleen that is larger than normal may remove or store too many platelets. As a result, 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 but it usually does not require treatment. 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 your symptoms. You may not need treatment for mild thrombocytopenia. 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. You will also need to treat any 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 heparin-induced thrombocytopenia, 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, romiplostim, or avatrombopag 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 IV line into one of your blood vessels. You receive healthy blood or platelets through the IV. Learn more about blood transfusions.
• Surgery to remove your spleen can help increase the platelet count in your blood. Your spleen stores platelets. Possible complications include bleeding, infection, and abnormal blood clots.

Activity recommendations

Due to the risk of bleeding with a low platelet count, your provider may ask you to avoid strenuous exercise, contact sports, or other activities. They may recommend walking, stationary cycling, or strength training instead. People with extremely low platelet counts may need to avoid any strain. Discuss appropriate activities with your provider.

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