Thrombocytopenia: Symptoms, Causes and Treatments

The Thrombocytopenia Is a disorder in which there is a relative decrease of the platelets, commonly known as platelets, present in the blood.

A platelet count of less than 150,000 platelets per microliter is considered a lower than normal value, so thrombocytopenia is present.

Thrombocytopenia

Platelets are one of the cellular components of the blood, along with white blood cells and red blood cells. These play an important role in coagulation and bleeding.

Platelets occur in the bone marrow, like other blood cells, and originate from megakaryocytes. The fragments of these megakaryocytes are released into the bloodstream.

Circulating platelets make up about two-thirds of the platelets that are released from the bone marrow. The other third is typically stored in the spleen. These, in general, have a short shelf life in the blood (7 to 10 days), after which they are removed from circulation.

The number of platelets in the blood is known as the platelet count and is usually between 150,000 to 400,000 per microliter (1 million liters) of blood.

Platelet counts below 150,000 are called thrombocytopenia. A platelet count greater than 400,000 is called thrombocytosis.

Platelets participate in the coagulation process, because they initiate a sequence of reactions that eventually lead to the formation of a blood clot.

These circulate in the blood vessels and are activated if there is bleeding or injury in the body. When activated, platelets become sticky and adhere to the blood vessel wall at the site of injury to slow and stop bleeding by covering the damaged blood vessel or tissue (hemostasis).

The risk of severe bleeding does not occur until the count becomes very low: less than 10,000 or 20,000 platelets per microliter. Mild bleeding sometimes occurs when the count is less than 50,000 platelets per microliter.

In mild thrombocytopenia, there may be no adverse effects on blood clotting or bleeding pathways, and these effects vary from person to person with different low platelet counts.

It is important to note that although the number of platelets decreases in thrombocytopenia, its function often remains completely intact.

There are other disorders that can cause an alteration of platelet function despite the normal platelet count.

The duration of thrombocytopenia depends on its cause, so it can last from days to years.

Causes

The different causes of thrombocytopenia are listed below. These causes are not mutually exclusive and more than one may be responsible for an abnormal platelet count.

  1. False thrombocytopenia: clot in the sample; The platelets were pooled.
  2. Congenital thrombocytopenia: rare inherited disorders such as Hegglin's anomaly in May, Bernard Soulier syndrome, among others.
  3. Defective platelet production: aplasia of the bone marrow (failure); Metabolic disorders, for example, renal failure, alcohol; Precursors of abnormal platelets: viral infections, hereditary anomalies; Infiltration of the bone marrow, for example, leukemia, lymphoma.
  4. Decreased platelet survival: antibodies in response to drugs, blood transfusion or other disease, eg glandular fever, malaria; Unknown cause (ITP); Coagulation disorder (DIC); Disorder of the blood (TTP).
  5. Loss of circulation platelets: massive blood transfer or exchange; Enlarged spleen.

symptom

Thrombocytopenia usually has no symptoms, but these may appear suddenly or over time.

  1. - Bleeding: more often in the gums or nose, there may also be blood in the urine or stools. Women with thrombocytopenia may have longer periods.
  2. - Red and flat spots on the skin the size of a pinhead, which can be seen mainly in the legs and feet, and may appear in groups. The doctor may call them petechiae.
  3. - Stains and bruises: it is possible the presence of large areas of bleeding under the skin that do not turn white when pressed. You can also see what the bruises look like if the person had stumbled or been hit. They can be blue or purple and change to yellow or green over time. These are caused from the inside by the sudden leakage of small blood vessels.
  4. Severe thrombocytopenia can cause a large amount of bleeding after an injury or fall.

How to get a diagnosis

Thrombocytopenia is often discovered by chance when the doctor does a routine blood test.

The doctor will surely ask questions like:

  1. If bleeding or unusual symptoms have been noted.
  2. If you have bruises and when you first saw them.
  3. If you are taking medications and supplements.
  4. If you have had an injection in the last month, such as a blood transfusion or injected drug.
  5. If there is anyone in the family with problems in their immune system.

The doctor will then perform a physical examination to check for signs of bleeding, bruising, and checking if the spleen seems to feel large.

There are also some tests that check for low levels of platelets, such as: a complete blood count that measures the number of red blood cells, white blood cells and platelets; Blood smear showing how platelets look under a microscope; And bone marrow testing.

In the bone marrow test the doctor uses a very fine needle to extract a small amount of liquid bone marrow and check for cells that may not be working well. Or you can get a biopsy with a different kind of needle, in order to check the types and numbers of cells in the bone marrow.

It is possible that other than those indicated in this article, more tests may be needed to help the doctor find out the cause and indicate the treatment.

Treatment

Treatment of thrombocytopenia depends on its cause and severity. The primary goal of treatment will be to prevent death and disability caused by bleeding.

If your condition is mild, you may not need treatment. Thrombocytopenia often improves when it treats its underlying cause. In fact, people who inherit the condition generally do not need treatment.

If a reaction to a drug is causing a low platelet count, the doctor will stop or prescribe another medication. Most people recover after the initial drug has been stopped.

However, for heparin-induced thrombocytopenia, its discontinuation will not be sufficient. You will often need another medication to prevent blood clotting.

If your immune system is causing a low platelet count, your doctor may prescribe medications to suppress the immune system.

In the case of severe thrombocytopenia, the doctor may prescribe treatments such as medications, splenectomy, blood transfusions, or platelets.

Also, your doctor may prescribe corticosteroids, known as steroids. Steroids can slow the destruction of platelets. These medicines can be given orally. An example of this type of medication is prednisone.

Steroids used to treat thrombocytopenia are different from illegal steroids adopted by some athletes to improve performance.

On the other hand, your doctor may prescribe immunoglobulins or medications such as rituximab to block the immune system, or other medications, such as eltrombopag or romiplostim, to help the body produce more platelets.

You may be interested in 7 Best Foods to Produce Platelets .

Blood or platelet transfusions

Blood or platelet transfusions are used to treat people who have active bleeding or are at high risk for bleeding. During this procedure, a needle is used to insert an intravenous line into one of the blood vessels. Through this line, you receive healthy blood or platelets.

Splenectomy

Splenectomy is surgery to remove the spleen. This surgery can be used if drug treatment does not work. It is also used primarily in adults who have immune thrombocytopenia. However, medications are often the first course of treatment.

Risks of thrombocytopenia

Thrombocytopenia can be fatal, especially if bleeding is severe or occurs in the brain. However, the general perspective for people who have the condition is good, especially if the cause of low platelet count is found and treated.

There is no close relationship between platelet count and bleeding severity, but there is an increased risk of bleeding if the number of platelets decreases or if platelet function is affected (eg aspirin and ibuprofen, Which reduces the adhesion of platelets).

There is a particularly high risk of spontaneous bleeding once the platelet count falls below 10 million per ml. Bleeding is usually seen on the skin in the form of small punctured haemorrhages (purple), or bruising (ecchymosis) after minor trauma.

The most serious hemorrhage of the eye can occur in the back, specifically in the retina, sometimes threatening the eyesight.

The most serious, potentially fatal, complication is spontaneous bleeding within the head (intracranial) or lining of the intestine (gastrointestinal).

Can thrombocytopenia be prevented?

Thrombocytopenia can usually not be prevented, however the possibility will depend on the specific cause.

Measures can be taken to prevent certain health problems associated with thrombocytopenia. For example: avoid drinking too much alcohol because it reduces the production of platelets; Try to avoid contact with toxic chemicals such as pesticides, arsenic, and benzene, which can delay the production of platelets; Or avoid medications that in the past have decreased the platelet count.

Also, be aware that there are medications that can affect platelets and increase the risk of bleeding. Two examples of these drugs are aspirin and ibuprofen, as these medicines can dilute the blood too much. Be careful when using over-the-counter medications, many containing aspirin or ibuprofen.

Finally, consult your doctor about getting vaccinated against viruses that may affect platelets. Vaccines may be needed for mumps, measles, rubella, and chickenpox.

Tips for living with thrombocytopenia

  1. Avoid medications that can affect platelets and thus increase the risk of bleeding.
  2. Avoid injuries that can cause bruising and bleeding, so it is advisable to skip the practice of contact sports such as boxing, soccer or karate. Other sports, such as skiing or horseback riding, are also risky. It is advisable to ask the doctor about physical activities that are safe.
  3. Take simple safety precautions, such as wearing a seat belt while driving in a car or wearing gloves when working with knives and other tools.
  4. If the child has thrombocytopenia, parents should try to protect him from injury, especially head injuries that can cause bleeding in the brain. It is advisable to ask the doctor if you need to restrict some activities.
  5. If the spleen has been removed, the person is likely to become ill from certain types of infections, so care should be taken with symptoms such as fever or other signs of infection and tell the doctor immediately On the appearance of them. People who have had their spleens removed may need shots to prevent certain infections.

References

  1. National Heart, lung and Blood Institute (2012). Explore Thrombocytopenia. U.S. Department of Health & Human Service. Retrieved from nhlbi.nih.gov.
  2. WebMed (2015-2017). Thrombocytopenia and ITP. WebMD, LLC. Retrieved from webmd.com.
  3. Atul Mehta (2012). What is thrombocytopenia?. NetDoctor. Retrieved from netdoctor.co.uk.
  4. Charles Patrick Davis (2016). Thrombocytopenia. Medicine Net. Retrieved from medicinenet.com.


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