Low Platelet Count(Thrombocytopenia): Causes and Treatment

Low platelet count is called thrombocytopenia – Thrombocytes mean “platelets,” and penia means “too few.” Your blood is made up of different types of cells, each with specific functions in the body. Platelets are small irregularly shaped cells that clump together, form clots, and stop you from bleeding. Your platelets are produced in the bone marrow and travel in the blood for about 10 days before they die.

For example, when you get injured, your platelets form clots and prevent you from bleeding out. When you don’t have enough platelets in your blood, your blood is unable to clot. Thrombocytopenia can run in families, and it can affect both children and adults. Usually, a low platelet count is caused by an underlying condition, such as leukemia, immune system disorders, or the use of certain medications.

The symptoms of thrombocytopenia can range from mild to severe, depending on its underlying cause. For some people, a slightly low platelet may be asymptomatic (shows no signs). Some others might experience severe bleeding. A meager platelet count could be life-threatening if left untreated. You’d better seek medical help as soon as possible.

Low Platelet Count
Low Platelet Count(Thrombocytopenia): Causes and Treatment

Normal Ranges of Platelet Count

A platelet count calculates the number of platelets in the blood. A doctor would carry a blood test (complete blood count) out in a laboratory. The average platelet count is around 150,000 to 450,000 platelets per microliter (μl) of blood.

When the number of platelets in your blood reduces, its concentration also decreases. If you have attention below 150,000μl, you have a low platelet count.

The lower your platelet count, the higher the risk of bleeding. However, excessive bleeding is unlikely unless your count falls below 80,000-100,000 platelets per μl.

You are at risk of severe bleeding if your platelet count falls within these ranges:

Between 20,000 and 50,000 per μl: You have a high chance of bleeding during injuries.

Less than 20,000 per μl: You may experience uncontrollable bleeding even without injury

Below 10,000 platelets per μl: Unexpected bleeding, which can be severe and life-threatening.

Top tip: Since a woman goes through different phases in her life, it’s not unusual for women to have a low platelet count during their menstrual period or pregnancy.

In most cases, having a low platelet count is not a cause of concern. However, instances of extreme thrombocytopenia can cause spontaneous bleeding in gums, eyes, bladder, and even death.

What are the symptoms of a low platelet count?

While some cases of thrombocytopenia are asymptomatic, others are not. The symptoms of your platelet count depend on the number of platelets in your blood or the underlying cause.

For example, mild cases such as pregnancy don’t usually accompany any symptoms. More severe cases, including immune disease, can result in spontaneous bleeding, which will require immediate medical attention.

The symptoms of low platelet count include:

  • Bleeding gums
  • Blood in the stool
  • Fatigue
  • Nosebleeds
  • Heavy menstrual bleeding
  • Red, purple, or brown bruises, which are called purpura
  • A rash with small red or purple dots called petechiae
  • Blood in your urine
  • Bleeding from wounds that persist for a prolonged period or don’t stop on their own
  • Bleeding from the rectum

In severe cases of thrombocytopenia, you may experience internal bleeding.

Symptoms of internal bleeding include:

  • Bloody or darkly colored vomit
  • blood in your urine
  • Blood in the stool

You must seek immediate if you notice any signs of internal bleeding. In rare cases, some patients may experience bleeding in their brains. If you have a low platelet count that accompanies headaches or neurological problems, visit your doctor immediately.

Common Causes of Low Platelet Count

Thrombocytopenia has many possible causes. The possible causes of a low platelet count include:

1. Bone marrow conditions

Your bone marrow is a spongy tissue inside the bone that produces your blood cells. A problem with your bone marrow can affect the production of the platelets, which in turn causes a low platelet count. The bone marrow can fail to produce platelets due to:

  • Aplastic anemia
  • Folate deficiency
  • Viral infections, including HIV, Epstein-Barr, and chickenpox
  • Vitamin B-12 deficiency
  • Iron deficiency
  • Exposure to chemotherapy, radiation, or toxic chemicals
  • Consuming too much alcohol; drinking too much alcohol can cause deficiency of certain nutrients required by the bone marrow to produce platelets. Alcohol itself may harm the bone marrow.

2. Immune thrombocytopenia (ITP)

In a healthy body, platelets can survive for up to 10 days. However, for some autoimmune diseases, certain medications, including cancer medications, diuretics, and anti-seizure medications, can cause the body to kill the platelets faster than usual.

ITP is one of the most common causes of low platelet count. Although the primary cause of ITP remains unknown, the condition happens when your immune system – (the body’s primary defense against disease) doesn’t function properly. In this condition, your immune system deploys antibodies that are supposed to eliminate pathogens but attack and destroy your platelets.

Secondary ITP occurs when ITP is linked to an autoimmune disease such as:

  • Viral infections (including parvovirus, chickenpox, hepatitis C, Epstein-Barr, and HIV)
  • Drug-induced immune thrombocytopenia
  • Systemic lupus erythematosus (SLE)
  • Chronic lymphocytic leukemia (CLL)
  • Sepsis, a severe bacterial infection in your blood
  • Helicobacter pylori (H. pylori), a bacteria that causes ulcers and sores in your digestive system

Medications responsible for ITP include:

  • Heparin, a blood thinner used to prevent blood clots
  • Certain drugs for heart problems, seizures, and infections
  • Certain cancer drugs

If medication is the cause of your low blood count, make sure you visit your doctor. He will help you adjust your dose or provide an alternative.

3. Cancer

Some specific types of cancers can cause low platelet count. The cancers that can cause thrombocytopenia include:

Leukemia: Leukemia is the cancer of the blood and bone marrow. Leukemia causes abnormal cell growth in the bone marrow, which could outgrow healthy blood cells and prevent the production of platelets. Certain types of cancer that spread to the bone can make it difficult for the bone marrow to produce platelets.

Cancer in the spleen: Your spleen is a large organ responsible for storing extra platelets in the body. Cancer causes abnormal growth in the spleen so that it may store more platelets than usual. This depletes the number of platelets in the blood where they are needed.

4. Low platelet count in women

Pregnancy is one of the most common causes of low platelet count in women. The body undergoes many changes during pregnancy, including increasing its blood plasma and blood volume. This means your body has more blood and the same number of platelets, a condition known as hemodilution.

Luckily, a low platelet count associated with pregnancy is not life-threatening. Most cases are asymptomatic. Other causes of low platelet count include:

  • Cirrhosis
  • Myelodysplasia
  • A bacterial infection in the blood
  • Hemolytic uremic syndrome
  • Idiopathic thrombocytopenic purpura
  • Thrombotic thrombocytopenic purpura
  • Disseminated intravascular coagulation
  • Radiation treatment on your bone marrow

When to see a doctor for low platelet count

Unfortunately, a low platelet count can be diagnosed only during a blood test. However, if you notice bleeding that doesn’t stop, you should seek immediate medical attention. Schedule an appointment with your doctor if you notice symptoms of thrombocytopenia.

Diagnosis

Blood tests can help detect a low platelet count. Your doctor will ask some questions that will address your family history, symptoms, and your current medications.

Your doctor will also carry out a physical examination to check your skin for rashes and bruising. If he sees signs of thrombocytopenia, he will require other blood tests to confirm his diagnosis.

These tests include:

  • A complete blood count (CBC)
  • A bone marrow test
  • A blood smear test, which looks at platelets under a microscope
  • Other blood tests to assess blood clotting

If your doctor suspects cases of bone marrow abnormalities, he may require a sample of your bone marrow – This is called bone marrow biopsy. If there’s no visible cause of low platelet count, your doctor may suggest treating ITP.

treatment for a low platelet count
treatment for a low platelet count

What is the treatment for a low platelet count?

There are several treatment options available for low platelet count. Ultimately, the severity of your condition will determine the type of treatment you will need.

For example, if your thrombocytopenia results from pregnancy, your doctor may hold off treatment and monitor your situation closely. Often, a mild case of thrombocytopenia reverses on its own.

If your low platelet count is ITP related, your doctor can suggest treatment, including:

Blood or platelet transfusions: A blood transfusion of platelet cells can boost blood clotting and prevent heavy or unexpected blood loss. However, the results are temporary. The platelets form a transfusion only last for about 3 days. The life of transfused platelets decreases with time. If you have many transfusions, the platelets do not usually last as long each time.

Changing medications: If your medicine is responsible for decreasing your platelet count, your doctor may adjust your dose or change the drugs altogether. For example, if your critical low platelet count results from chemotherapy, your doctor may administer a lower dose or longer waits between treatment sessions.

Corticosteroids to block platelet antibodies: Corticosteroids are drugs that can help boost your platelet count. Oprelvekin (Neumega) is a drug that can prevent extremely low platelet count.

Other treatment methods include:

  • Steroids
  • Drugs that suppress your immune system
  • Immune globulin
  • Spleen removal surgery (splenectomy)

Top tip: Your doctor should advise you to wait till your platelet count gets back to normal. This is to reduce the risk of excessive bleeding during the operation. Your doctor will diagnose and determine the best treatment for you.

Preventing Low platelet count

There are various ways to increase your platelet count naturally. Eating foods rich in iron, folate, and vitamin B-12 equip your body with the nutrients it needs to make platelets.

Your doctor may recommend that you take extra measures to prevent your condition from worsening. This could include:

  • Avoiding contact sports
  • Reducing alcohol consumption
  • Avoiding activities with a high risk of bleeding or bruising
  • Stopping or switching medications that affect platelets, including aspirin and ibuprofen

What to Do If Bleeding Starts

Bleeding can be fatal for someone with an extremely low platelet count. If you start bleeding, ensure you seek immediate medical assistance. Follow these steps to minimize bleeding:

  • Sit or lie down. Try to stay calm.
  • Apply pressure to the wound if it’s an open wound.
  • Place an ice pack on the wound to slow the bleeding.
  • Raise your legs above the level of your heart if the injury is on an arm or leg.
  • If you notice blood in your urine, drink more fluids and contact your doctor right away.
  • Call your doctor if you detect blood in your vomit. Take anti-nausea and antacid medicines as prescribed by your doctor.
  • Tampons should not be used if have vaginal bleeding. Keep note of the number of sanitary pads you use. Take note of any clotting in your menstrual pad. 

Wrap up

Fortunately, low platelet is not a death warrant. Treatment is not necessary for everyone who has a low platelet count. Some diseases that produce thrombocytopenia will resolve on their own, and your platelet count should return to normal.

People with severe thrombocytopenia, on the other hand, may require treatment. Thrombocytopenia is usually corrected by addressing the underlying cause. Your doctor will collaborate with you to develop a treatment plan that will help you manage the symptoms.

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