Thrombocytopenia (Low Platelet Count): Symptoms and Treatment

In adults, the normal number of platelets ranges from 150,000 to 450,000 per microliter. A number below 150,000 indicates thrombocytopenia related to the platelet disorder. Symptoms may appear suddenly or gradually, but sometimes they are not present.

Platelets, also called thrombocytes, are produced in the bone marrow from larger cells. When injured, platelets form a plug, called a blood clot or thrombus, to seal the wound.

A low platelet count makes it difficult to stop bleeding. This can happen inside, under, or on the skin. Serious complications arise when the number is very low. Seek early treatment to prevent life-threatening hemorrhages, especially in the brain.

Platelets can also become activated when they detect a foreign invader in the body, releasing proteins to fight the infection. In addition to an increased likelihood of not being able to stop bleeding, thrombocytopenia can also reduce your body’s chances of fighting infection effectively.

Thrombocytopenia is likely underdiagnosed and underreported because many people experience only mild symptoms.

Thrombocytopenia is usually associated with bleeding. Symptoms may appear suddenly, slowly, or not at all. The disease is often detected through routine blood tests.

Common signs of bleeding in thrombocytopenia may include:

• Prolonged bleeding, even from minor injuries
• Petechiae, which are small, flat red spots under the skin, are caused by a leak in your blood vessels.
• Purpura or bleeding in the skin resulting in red, purple, or brownish-yellow spots
• Nosebleeds or bleeding gums
• Blood in the urine (hematuria) or stool (hematochezia), making it appear bright red or a dark, tarry color
• Heavy menstrual bleeding
• Bruises

Thrombocytopenia is usually caused by one of three causes. These are insufficient production of platelets in your bone marrow, increased breakdown of platelets in your bloodstream, and increased breakdown of platelets in your spleen or liver.

Other conditions and factors can affect the production of platelets in your bone marrow, including:

• Aplastic anemia, which occurs when your bone marrow fails to produce adequate numbers of blood cells
• Bone marrow cancers like leukemia
• Cirrhosis, a disease characterized by scarring of the liver
• Folate deficiency
• Rare infections affecting the bone marrow
• Myelodysplastic syndrome, which occurs when the bone marrow produces too few healthy blood cells or produces defective cells
• Vitamin B12 deficiency

Thrombocytopenia may also occur with the use of certain medications, including chemotherapy. A 2021 study found that 13% of people treated for solid tumors and 28% of those with hematologic malignancies, such as leukemia, developed thrombocytopenia during the first three months of chemotherapy.

Environmental exposure to toxic chemicals like pesticides, arsenic, and benzene can also hinder healthy platelet production. Unhealthy lifestyle habits, such as excessive alcohol consumption, can temporarily lower your platelet count, especially in people with low levels of vitamin B12 or folate.

To diagnose thrombocytopenia, your doctor will start by collecting information about your medical and family history. They will also ask you about any symptoms you may be experiencing and perform a physical exam to identify any signs of bleeding.

Your provider may think more blood tests are needed. For example, a complete blood count, or CBC, may be requested. This test measures the levels of platelets and other blood cells in your bloodstream.

Another test your provider may order is a blood smear. This involves placing a small sample of your blood on a slide and examining it under a microscope to examine your platelets in more detail. Additionally, bone marrow tests may be ordered to assess the overall health of your bone marrow.

If your doctor suspects that you have thrombocytopenia or another bleeding disorder, he or she may refer you to a hematologist. Hematologists specialize in the diagnosis, treatment and management of blood-related conditions.

The treatment approach to thrombocytopenia varies depending on the underlying cause and the presence of symptoms. In cases of mild thrombocytopenia, treatment may not be necessary.

However, if you experience heavy bleeding or are at high risk of complications, your doctor may recommend various medications or procedures. Treating the underlying condition causing the low platelet count is also important and will be part of the treatment regimen.

Drugs

Sometimes medications can cause low platelet levels. If this is the case, your provider may prescribe another medication. In cases where your immune system is the cause of a low platelet count, your doctor may prescribe medications that suppress your immune response (immunosuppressants).

Medications such as corticosteroids (eg, prednisone) are commonly used to increase platelet counts. Other medications like Promacta (eltrombopag) and Nplate (romiplostim) can help stimulate platelet production.

Monoclonal antibody medications such as Rituxan (rituximab) are medications that can help prevent your immune system from destroying platelets.

Procedures

If medications are ineffective, certain procedures may be considered.

Blood or platelet transfusions are used in individual cases of heavy bleeding or in people at high risk of bleeding.

In some cases, surgical removal of the spleen, also called splenectomy, may be necessary to improve the levels of platelets in your bloodstream. However, this procedure carries potential risks, including bleeding, infection, and abnormal blood clots, so other treatment options may be offered first.

Ask your doctor about any health problems you have or medications you are taking that may increase your risk of thrombocytopenia. Work with them to create a treatment plan to reduce this risk, if possible.

Thrombocytopenia can be influenced by the following medical conditions:

• Autoimmune diseases: These include immune thrombocytopenia (ITP), lupus, and rheumatoid arthritis, which can mistakenly trigger your immune system to attack and destroy platelets.
• Cancer: This includes blood cancers such as leukemia or lymphoma. These types of cancer, as well as cancer treatments like radiation and chemotherapy, can damage your bone marrow and destroy blood stem cells.
• Conditions that cause blood clots: These include thrombotic thrombocytopenic purpura (TTP) and disseminated intravascular coagulation (DIC).
• Bacterial and viral infections: Thrombocytopenia can occur during chronic infections such as hepatitis B, hepatitis C, and human immunodeficiency virus (HIV).
• An enlarged spleen: Although rare, an enlarged spleen can be caused by certain conditions, such as liver disease and leukemia.
• Pregnancy: Mild thrombocytopenia may develop when you are close to giving birth. It is possible to notice a gradual decrease in platelets from the first trimester until birth. This is attributed to the body’s need to support the growth of the fetus.
• Some surgical procedures: Platelets can be destroyed during surgeries involving artificial heart valves, blood vessel grafts, or the use of machines and tubes for blood transfusions or bypass surgery. This can occur as they pass through these artificial structures and equipment, leading to a decrease in platelet counts.

The prognosis for thrombocytopenia varies and depends on the cause. The best way to prevent complications of thrombocytopenia is to work with your doctor to establish a treatment regimen and determine what lifestyle changes you should make. Infection prevention measures should also be taken.

Tell your doctor if you have symptoms of infection, such as fever. Having your spleen removed increases your risk of infection. In this case, your provider can discuss steps to take to reduce your risk of infection, such as getting vaccinated. Watch for symptoms of bleeding, which can quickly become a medical emergency.

If you smoke, quitting can make a huge difference to your health. Smoking can increase the risk of developing a blood clot.

Avoid contact sports and ask your provider about what physical activities are safe for you. Take safety precautions, such as using a seat belt when driving a car and wearing gloves when working with knives and other tools.

Be sure to take all medications as prescribed. Before any surgical or dental procedure, tell your doctor about any medications you are taking that may lower your platelet count.

These medications may increase bleeding during these procedures. Avoid medications that may lower your platelet count or prevent your platelets from working properly. Aspirin and Advil (ibuprofen) are commonly used medications that can thin your blood too much.