Thrombocytopenia

Thrombocytopenia is a condition that occurs when the platelet count in the 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.
• Mortality is rare, and the majority of cases are managed successfully with conventional treatments.

Symptoms

• 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

Diagnosis

• medical and family history
• physical exam to look for signs of bleeding
• 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 the bone marrow is healthy.

Causes

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.

• May have a low platelet count for the following reasons:
  • The body’s bone marrow does not make enough platelets.
  • The bone marrow makes enough platelets, but your body destroys them or uses them up.
  • The spleen holds on to too many platelets (enlarged spleen)
    • Increased breakdown of platelets in the spleen or liver
    • The spleen is an organ in the abdomen. It normally stores about one-third of the body’s platelets. It also helps the body fight infection.
• These factors can raise the 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

• Treatment depends on the cause and if there are any symptoms. If mild thrombocytopenia no treatment may be needed.
• If serious bleeding or a high risk of complications, medications or procedure may be needed as well treating the cause of the low platelet count.
• If the immune system is the cause of the low platelet count, medicines to suppress the immune system may prescribed.
• Corticosteroids may be prescribed and immunoglobulins and rituximab can help stop the immune system from destroying platelets.
• Blood or platelet transfusions may be used to treat those who are bleeding heavily or are at a high risk of bleeding*
• Surgery to remove your spleen (splenectomy) can help increase the platelet count, however, possible complications include bleeding, infection and abnormal blood clots.

Prognosis

• Thrombocytopenia, if not treated properly, can cause complications like organ damage and even fatality.
• Depending upon the cause, thrombocytopenia can be prevented, especially if early medical attention is received
• Many causes are still not preventable.

Resources & additional reading===:

• [https://www.nhlbi.nih.gov/health/thrombocytopenia#:~:text=Thrombocy.... NIH – Thrombocytopenia; Platelet Disorders]
• Cleveland Clinic – Thrombocytopenia
• WebMD -- Thrombocytopenia (Low Platelet Count)
• Wikipedia -- Thrombocytopenia
• Mayo Clinic -- Thrombocytopenia (low platelet count)
• MedlinePlus -- Thrombocytopenia
• NIH- Mortality in thrombocytopenia purpura: report of seven cases and consideration of prognostic indicators—by: E Schattner, J Bussel;
• MeD India—Thrombocytopenia / Low Platelet Count (image + info)
• Pain Assist -- Causes of Low Platelet Count or Thrombocytopenia, Its Effects & Ways to Increase Platelet Count Naturally; By: Pramod Kerkar, MD FFARCSI, DA Pain Assist Inc (image + info)