Thrombocytopenia

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at December 14, 2016
StartDiseasesThrombocytopenia

Thrombocytopenia occurs when platelet counts are down. Platelets are essential for clotting, which is the process the body uses to stop bleeding. Thrombocytopenia can cause dangerous bleeding and may require medical treatment. 

Contents

Definition & Facts

Thrombocytopenia is a medical term used to describe platelet blood levels that are lower than the acceptable range. This refers to platelet counts that are fewer than 150,000 per microliter of blood. The condition gets its name from the word thrombocytes, which is the scientific name for platelets.

Low platelet counts are caused by several conditions and can affect all ages, races, and both men and women. The condition may be temporary or permanent. In severe cases where counts drop below 10,000, sudden bleeding and internal bleeding may occur and could be fatal. 

Symptoms & Complaints

Thrombocytopenia may present with a variety of symptoms, or it may be asymptomatic meaning it does not have observable symptoms. The most common complaints are similar to those of other medical conditions that affect the blood, including anemia and some cancers, so proper medical testing is necessary to confirm the underlying cause when symptoms of a blood disorder are present.

In most cases, excessive bleeding and slow clotting are the primary complaints. In the most severe cases, thrombocytopenia can cause serious internal bleeding, which may affect the brain and could potentially be fatal. Some common symptoms of thrombocytopenia include:

Causes

Low levels of platelets are caused by one of three processes. Either the body is not producing enough platelets or too many platelets are being destroyed or an unusually high number of platelets are being captured in the spleen.

A wide range of conditions, deficiencies, and disorders may result in a low platelet count. It is also possible for the condition to be hereditary, appearing more commonly in families where there is already a history of the condition.

Certain conditions may cause low platelet counts, including anemia, autoimmune diseases, lupus, and bone marrow disease. It is also possible for thrombocytopenia to be caused by pregnancy, although that form is generally self-correcting. 

There are also some serious medical issues that can cause platelet counts to drop below acceptable levels. It could be brought on by viral infections or bacterial infections, particularly those that infect the blood or affect the entire body. Blood cancers and bone marrow cancers can also dramatically impact platelet levels. Severe vitamin deficiencies may also be to blame.

There are also certain medical treatments that may cause thrombocytopenia. These include radiation therapy, chemotherapy, blood thinning treatments and medications, treatments and medications for cardiovascular disease, and some seizure medications. The disorder may also have no discernible cause, sometimes occurring and resolving without an obvious reason. 

Diagnosis & Tests

Thrombocytopenia is easily identified through a routine blood test known as a complete blood count or CBC. If platelet levels are below 150,000 per microliter of blood, the platelet count is considered low, and thrombocytopenia is diagnosed. The large number of medical concerns that can cause the condition make identifying the underlying cause of a low platelet count more involved, however.

A person's doctor will need to discuss the patient's full medical history, including any genetic disorders that could cause low platelet levels or the associated symptoms. A physical examination will be conducted to look for the physical symptoms of thrombocytopenia and check for an enlarged spleen. 

In addition to the CBC, blood samples will be tested for clotting time, bacterial cultures, and may be examined under a microscope as a blood smear. This will help the doctor and other medical staff look for signs indicating the specific cause of the condition. Additionally, the doctor may need to analyze bone marrow for indications of some conditions and types of cancer.

An ultrasound or other diagnostic imaging techniques may be used to check for enlargement of the spleen, abnormal bone or marrow growths, and other signs of cancer or disease. Once the underlying cause of low platelet levels has been determined, appropriate treatment can begin. 

Treatment & Therapy

If platelet levels are severely low, initial treatment will be geared towards raising platelet production and increasing levels until they reach safe numbers. This initial treatment may not be necessary if levels are not severely low. If it is necessary, treatments may include immunoglobulin treatments administered by intravenous or IV fluids. This should rapidly boost platelet counts.

A blood transfusion may also be required for serious cases of thrombocytopenia. This may involve a blood transfusion, platelet transfusion, or plasma exchange to add platelets and other healthy blood cells to the body quickly. These short-term treatments will aid in stabilizing platelet levels so that further therapy can be used to treat the underlying condition. 

The exact treatment prescribed may vary depending on why the platelet levels are low. Some cases will not require any treatment. If treatment is needed, any of the following methods may be used:

  • Corticosteroids – this category of steroid may be prescribed on a short-term or longer basis to help control immune response and aid the body in maintaining normal platelet levels. 
  • Biologics – these medications are used to destroy while blood cells and antibodies that are destroying platelets. This treatment is usually coupled with other therapies designed to treat the immune condition causing the problem. 
  • Immunosuppressive drugs– this type of drug is usually prescribed on a long-term basis. Its purpose is to stop the body from attacking platelets so they can maintain normal levels. 
  • Thrombopoietin receptor agonists – this medication boosts platelet creation and can be prescribed on a long-term basis to manage the thrombocytopenia. 
  • Spleen removal– If the spleen is responsible for destroying platelets it may need to be surgically removed.

Prevention & Prophylaxis

Preventing thrombocytopenia, maintaining platelet counts within normal range, and avoiding complications from related symptoms like bleeding and trouble clotting in the future may require some lifestyle changes.

It is important to continue taking any prescribed medications as directed by the doctor. A patient will need to return for any required follow-up visits with the doctor as well. This will allow them to monitor the condition and take action if necessary before platelet levels drop too low.

One should limit high-risk activities such as contact sports and any activities that may result in injury that could cause bleeding. Additionally, one should avoid medications and products like alcohol that can increase bleeding risks or thin the blood.