Thrombocytopenia is a condition in which your blood platelet count is abnormally low. Platelets, also known as thrombocytes, form blood clots by clumping together to stop bleeding at the location of the wound or cut.
The soft, spongy substance in the bones that produce all blood cells, as well as platelets, is known as bone marrow. However, in people with thrombocytopenia, the platelets are insufficient to form a blood clot. This means that you might bleed excessively if you sustain a cut or an injury, and it may difficult to stop.
Thrombocytopenia can be minor, with minimal symptoms or signs. Rarely, the number of platelets might be too low that internal bleeding becomes serious. Treatment isn't necessary for everyone who has a low platelet count. Some of the disorders that produce a low platelet count will improve over time. In such cases, the platelet count will eventually return to normal.
Signs and Symptoms of Thrombocytopenia
The number of platelets in the blood determines whether or not you get symptoms. Mild situations, including when a low platelet count is due to pregnancy, are often asymptomatic. In more serious cases, uncontrollable bleeding may occur, necessitating immediate medical intervention.
If your platelet count is low, you may have the following symptoms;
- A rash characterized by small purple or red dots known as petechiae
- Purple, red, or brown bruises referred to as purpura
- Nose bleeding
- Bleeding of the gums
- Unusually heavy menstrual flow
- Bleeding from cuts or wounds that do not stop on their own or linger for a longer period
- Blood in the stool or urine
- Rectal bleeding
For the more severe situations, internal bleeding might occur. The signs and symptoms that might indicate internal bleeding are;
- Blood in the stool
- Blood in the urine
- Dark or bloody vomit
Causes of Thrombocytopenia
In rare cases, thrombocytopenia is a hereditary disorder. On the contrary, a variety of drugs or illnesses can cause it. Regardless of the cause, the platelets circulating in the body diminishes by one or more processes such as;
Platelet trapping in the spleen:
The spleen is the small organ nearly the size of the fist that is located on the left side of the abdomen immediately below the rib cage. Your spleen's function is to combat infection and filter undesirable particles from the blood in normal circumstances. An enlarged spleen, which can be due to a variety of conditions, can hold an excessive number of platelets. This reduces the number of platelets circulating in the body.
Decreased platelet production:
When the bone marrow cannot produce sufficient platelets, the overall platelet count in the body reduces. Some of the factors that can contribute to the low production of the platelet include;
- Leukemia and other types of cancers
- Certain forms of anemia
- Chemotherapy medications or radiation
- Viral infections, including HIV and hepatitis C
- Excessive alcohol consumption
Increase in the platelet breakdown:
Certain disorders cause the body to utilize or destroy platelets more quickly than they are created. Eventually, this will result in a platelet deficit in the bloodstream. The following are some examples of such conditions;
- Pregnancy: Pregnancy thrombocytopenia is usually mild and tends to improve quickly after delivery.
- Immunological thrombocytopenia: This can occur due to autoimmune disorders like rheumatoid arthritis or lupus. The immune system attacks or destroys the platelets by mistake. Idiopathic thrombocytopenic purpura is a term referred to this condition if the specific cause is unknown. Children are more likely to be affected by this type.
- Thrombotic thrombocytopenic purpura: This is an uncommon illness in which small blood clots develop suddenly all over the body and consume a huge amount of platelets.
- Hemolytic uremic syndrome: This is an uncommon condition that involves a significant decline in platelets, red blood cell breakdown, and kidney dysfunction.
- Bacteria in the blood: Bacteremia (severe bacterial infections of the blood) can damage platelets.
- Drugs: Some medications can result in a decrease in platelet count in your bloodstream. When a medication confuses the body's immune system, it causes platelet destruction. Quinine, heparin, antibiotics containing sulfa, and anticonvulsants are some of the common examples.
The doctor will start by conducting a physical test if he or she suspects a reduced platelet count. During the examination, your doctor will look for atypical bruising or signs of petechiae. This is an indication of capillary bleeding that frequently occurs with a low platelet count.
Also, the doctor might examine your belly for an enlarged spleen, which might result in a low platelet count. If necessary, they can as well ask if you have a family history of bleeding problems. This is because such conditions can pass down through generations.
- Blood tests
A complete blood count test is necessary to diagnose this illness. A blood test examines the number of blood cells in the system. In case the platelet count is low than normal, it will alert your doctor. Generally, a typical platelet count per milliliter of blood will be between 150,000 and 450,000 platelets.
The blood test can also include blood clotting tests such as prothrombin time and partial thromboplastin time.
If necessary, the doctor can examine the blood for platelet antibodies, which are platelet-destroying proteins. Platelet antibodies can develop as a result of certain medications, including heparin, or due to other unexplained reasons.
An ultrasound is essential if your medical provider suspects the spleen is enlarged. The test will create an image of the spleen using sound waves. This can assist your doctor in determining the actual size of the spleen.
- Biopsy and bone marrow aspiration
The doctor can recommend a bone marrow aspiration if he or she suspects an issue with the bone marrow. The aspiration procedure typically involves using a needle to remove small bone marrow from one of the bones.
A bone marrow biopsy might be required as well. The doctor will extract a sample of the core bone marrow, mostly from the hipbone, with a needle. This can be done in conjunction with a bone marrow aspiration.
Thrombocytopenia usually lasts for a few days, weeks, or sometimes years. Mild thrombocytopenia may not require any form of treatment. On the other hand, the treatment for thrombocytopenia varies depending on the cause and severity of the condition.
When thrombocytopenia is due to an underlying ailment or a certain drug, treating the trigger may be enough to cure it. For people with heparin-induced thrombocytopenia, the doctor may recommend a different blood thinner.
Other thrombocytopenia treatment options include;
Platelet or blood transfusions: If the platelet count drops too low, the medical provider can give you transfusions of packed platelets or red blood cells. This helps replace the blood you've lost.
Drugs: The doctor may recommend medications to enhance your platelet count if the condition is linked to an immune system issue. A corticosteroid may be the first medicine of choice. In case it does not work, more strong immune-suppressing medication can be prescribed.
Surgical procedures: If the other alternative therapies fail, your doctor may suggest removing your spleen through surgery (splenectomy).
Plasma interchange: Thrombotic thrombocytopenic purpura can be life-threatening; hence plasma exchange might be necessary.
Complications of Thrombocytopenia
Significant external and internal loss of blood, or hemorrhage, is a major risk for those with serious thrombocytopenia. Internal bleeding (intracranial hemorrhage) into the digestive system or the brain can be fatal.
You are more vulnerable to infection following a splenectomy. The spleen forms part of the body's immune system. It enables the body to battle against pathogens. As a result, patients whose spleens have to be taken out are given a series of vaccines to help in preventing the infection.
If you are at a high risk of developing thrombocytopenia, take the following precautions to avoid the problem.
- Avoid using blood-thinning drugs such as aspirin, Naprosyn, and ibuprofen as they raise the risk of bleeding.
- Avoid contact sports and other activities that could result in injuries, bruises, or bleeding.
- Reduce the number of harmful chemicals you come into contact with.
- When shaving, cleaning your teeth, or blowing the nose, be more cautious.
- Limit your alcohol consumption, as it reduces platelet production and damages the liver.
Thrombocytopenia and Pregnancy
Apart from anemia, thrombocytopenia (a blood platelet count of less than 150,000/L) is the second most common cause of blood problems in pregnancy. About 70 to 80 percent of all occurrences of thrombocytopenia in pregnancy are due to gestational thrombocytopenia.
Hypertensive diseases account for about 20 percent of the cases, while immune thrombocytopenic purpura accounts for approximately 3 to 4 percent. Other causes of pregnancy are considered uncommon.
It's critical to take care of and protect your health if you have diseases that raise your risk of getting thrombocytopenia. Excess bleeding and bruising might occur if your platelet count is low. If you have the condition, your healthcare provider will explain why your platelet count is low and discuss available treatment choices.
For a severe condition, you might be required to refrain from engaging in activities that put you at risk of injury or bleeding. Your doctor will also work with you to develop a suitable treatment regimen to help manage the symptoms.