What Is Thrombocytopenia?
Thrombocytopenia is the medical term used to describe a low platelet count. Platelets, also known as thrombocytes, are small cell fragments whose function is to regulate blood clotting. Thrombocytopenia is in contrast to other platelet count abnormalities, such as thrombocythemia and thrombocytosis.
Under normal conditions, the number of thrombocytes varies between 150,000 and 450,000 per microliter of blood. The person is estimated to have a low count when the value drops to about 50,000 per microliter. The condition is very common in patients who have had surgery, and those who are hospitalized in intensive care.
Causes of thrombocytopenia
Many factors can trigger a drop in blood platelet counts. As we have already pointed out, most of the cases are reported in surgical or hospitalized patients. In fact, it’s estimated that between 13% and 60% of these patients develop the condition.
It isn’t an exclusive condition in adults, and it’s relatively common in newborns. Experts categorize neonatal thrombocytopenia into two types: early and late. In the first case, it’s due to premature deliveries, while in the second it’s due to sepsis and necrotizing enterocolitis.
According to the National Heart, Lung, and Blood Institute, episodes of thrombocytopenia can be explained taking into account 3 hypotheses:
- The bone marrow doesn’t make enough thrombocytes (platelets).
- The bone marrow produces enough thrombocytes, but, for some reason, the body doesn’t use them or it destroys them.
- The spleen retains more platelets than it should.
You can develop this condition for one or more of these causes, which explain most of the episodes. According to the researchers, the most common triggers for thrombocytopenia are the following:
- Bone marrow failure (can be caused by aplastic anemia, Shwachman-Diamond syndrome, paroxysmal nocturnal hemoglobinuria, and others).
- Bone marrow suppression (by chemotherapy or radiation, for example).
- Congenital macrothrombocytopenias (Fanconi anemia, Alport syndrome, Wiskott-Aldrich syndrome).
- Infections (HIV, rubella, varicella-zoster virus, Epstein-Barr virus, hepatitis C virus, and others).
- Chronic alcohol abuse.
- Nutritional deficiencies (especially vitamin B12 and folates).
- Myelodysplastic syndrome.
- Liver disease (cirrhosis)
- Autoimmune syndromes (sarcoidosis, systemic lupus erythematosus, and others).
- Taking certain medications (such as diuretics).
We can continue to list more and more triggers, but these ones here account for a high percentage of reported cases. Thrombocytopenia can have multiple causes, which requires a meticulous diagnostic process to find the reasons for the reduction in values.
Since most of the time the decrease in platelets in the blood is minimal, patients don’t develop obvious symptoms. These only begin to appear when the reduction is moderate or severe.
In these cases, the following may appear:
- External bleeding (very close to the surface of the skin or on it and bruising)
- Blood in urine and stools
- Prolonged bleeding in minor cuts
- Vaginal bleeding or very heavy menstrual cycles
In severe cases, you can develop internal bleeding. It isn’t something that can be seen with the naked eye, but it does put life at risk. Those that develop in the brain and intestines are especially dangerous.
Diagnosis of thrombocytopenia
In general, a blood test is sufficient to assess whether the platelet count is in a lower range. When the test shows 50,000 thrombocytes per microliter (or less), the patient will be diagnosed with this condition.
In addition, other tests may be carried out (kidney function, liver enzymes, erythrocyte sedimentation rate, peripheral blood smear, and bone marrow biopsy). Parallel evaluations can be carried out to find the possible underlying cause.
The goal of the treatment for a low platelet count is to prevent death and complications associated with bleeding. Each case is treated in a personalized way, as some patients won’t require intervention, even if they theoretically have the thrombocytopenia condition.
Indeed, if there is no internal or external bleeding, if the response to coagulation is clear, and there are no catalysts for the condition, it’s very likely that the specialist will not decide to treat it. It’s often something that’s found in a routine test. If the decline is slight, they may choose to follow up for the next several weeks.
This is not the case in moderate and severe episodes. In these cases, treatment must be established that will be in line with the trigger of the condition. For example, if it’s due to an autoimmune disease, the specialist will treat the underlying pathology.
In severe cases, corticosteroids may be prescribed to delay the destruction of platelets. Immunoglobulins and drugs are also prescribed to block the immune system. Some medications, such as romiplostim or eltrombopag, are helpful in increasing platelet production.
Blood transfusions are reserved for patients with bleeding or for those with a high probability of suffering it. In special cases, the spleen may be removed (splenectomy). Patients should be monitored after treatment to ensure recovery and to assess that platelet levels have reached the healthy range.
Thrombocytopenia can’t be underestimated
Although there are cases of thrombocytopenia where medication isn’t required and it is simply monitored regularly by a laboratory, it isn’t a condition to take lightly. The consequences of the moderate and severe forms are serious.
We recommend that you consult a health professional if you have repeated bruising or notice that you bleed too much from small wounds. A simple blood test could help to solve the problem.It might interest you...
- Gauer, R., & Braun, M. M. Thrombocytopenia. American family physician. 2012; 85(6): 612-622.
- Gunnink, S. F., Vlug, R., Fijnvandraat, K., Van Der Bom, J. G., Stanworth, S. J., & Lopriore, E. Neonatal thrombocytopenia: etiology, management and outcome. Expert review of hematology. 2014; 7(3): 387-395.
- Parker, R. I. Etiology and significance of thrombocytopenia in critically ill patients. Critical care clinics. 2012; 28(3): 399-411.