Thrombocytopenia

Thrombocytopenia tends to occur more frequently in women than in men, particularly in adults. Individuals most at risk are those with conditions already known to cause low platelet counts. These include:

• Having a family background of immune thrombocytopenia (ITP)
• Suffering from autoimmune conditions such as lupus or rheumatoid arthritis
• Being diagnosed with cancer or undergoing chemotherapy or radiation therapy
• Exposure to harmful chemicals or experiencing adverse drug reactions
• Chronic heavy alcohol use
• Pregnancy

Medical History

A detailed medical history plays a vital role in identifying the root cause of thrombocytopenia. Your doctor may ask the following:

• Any past or ongoing bleeding episodes
• Prior platelet count results and any recent changes
• Exposure to or symptoms of bacterial, viral, or rickettsial infections
• Risk factors for HIV infection
• Recent travel to areas where malaria, dengue, or Ebola are common
• Dietary intake, especially regarding vitamin B12, folic acid, or copper
• Symptoms of autoimmune diseases like systemic lupus erythematosus or rheumatoid arthritis
• History of surgeries like bariatric procedures or blood transfusions
• Use of prescription or over-the-counter drugs, including quinine-containing drinks or herbal teas
• If hospitalized, whether the patient received any heparin products
• Family history of bleeding disorders or low platelet counts
• In pregnant women, symptoms such as headaches, visual disturbances, abdominal pain, or flu-like symptoms

Physical Examination

The examination includes:

• Checking for red or purple skin spots which may indicate bleeding
• Palpation of the abdomen to detect an enlarged liver or spleen
• Examination for any swollen lymph nodes

Blood Tests

• Complete Blood Count (CBC): Determines the total number of blood cells, including platelets. A normal platelet count ranges from 150,000 to 450,000 per mL. Indices like mean platelet volume (MPV) and platelet distribution width (PDW) are also analyzed.
• Peripheral Blood Smear: A blood sample is examined under a microscope to assess the platelets' appearance.
• Platelet Antibody Test: Detects antibodies that may be mistakenly targeting platelets. This test is useful if there are unexplained bleeding symptoms and may be warranted when specific drugs are suspected.
• Coagulation Profile: Tests such as prothrombin time (PT) and partial thromboplastin time (PTT) assess how long blood takes to clot.

Additional Tests:

• Liver and kidney function tests
• Measurement of vitamin B12, folate, and copper levels

Imaging

An ultrasound of the abdomen may be done if an enlarged spleen is suspected, allowing visualization of spleen size.

Bone Marrow Aspiration and Biopsy

These procedures help determine if the bone marrow is functioning correctly. A needle extracts bone marrow fluid or tissue for analysis, especially when marrow disorders are suspected.

Prevention of Thrombocytopenia

Although not all cases can be avoided, especially when due to underlying conditions, some steps can lower the risk:

• Limit alcohol consumption to prevent impaired platelet production.
• Avoid exposure to harmful chemicals such as benzene and arsenic.
• Consult your doctor about alternative medications if your current drugs affect platelet count. Drugs like aspirin or ibuprofen can increase bleeding risk.
• Prevent viral infections through hand hygiene and basic cleanliness.
• Ask your healthcare provider about vaccinations for viruses like measles, mumps, rubella, and chickenpox. Ensure children receive routine immunizations.
• Refrain from high-risk activities that could result in injuries or bruises, such as contact sports.

When to See a Doctor

Consult a physician if you notice unusual symptoms such as easy bruising, purplish or reddish spots on your skin, blood in urine or stool, abnormal menstrual bleeding, or neurological signs like headaches. These could signal a low platelet count. Doctors to consider include:

• General physician
• Hematologist

The treatment approach depends on both the cause and the severity of the condition. The main goal is to prevent complications such as excessive bleeding or life-threatening outcomes.

In many mild cases, no specific treatment is needed. These cases may resolve on their own or once the underlying cause is addressed. For instance, infection-related thrombocytopenia often improves as the infection is treated. If caused by medication, stopping the offending drug usually leads to recovery.

For cases related to immune system dysfunction, medications to suppress immune activity may be prescribed.

A) Medications

1. Corticosteroids (e.g., dexamethasone, prednisone): Used to slow down platelet destruction. They may be given orally or via injection.
2. IV Immunoglobulins (IVIG): Used when corticosteroids aren't suitable or if platelet counts drop again after stopping steroids.
3. Rituximab: An immune-suppressing drug used for persistent ITP.
4. TPO Receptor Agonists (e.g., eltrombopag, romiplostim, avatrombopag): These platelet-stimulating drugs are used if steroids, surgery, or rituximab aren't effective. They are often used long-term.
5. Fostamatinib: A newer option for chronic immune thrombocytopenia that doesn't respond to standard treatments.

B) Blood or Platelet Transfusions

For patients experiencing significant bleeding or with very low platelet counts, transfusions are necessary. A needle is used to deliver platelets or blood directly into the bloodstream. However, this is a short-term solution, as transfused platelets remain in the system for only about three days.

Two common methods:

• Random Donor Platelet Concentrates (RDPC): Made by pooling platelets from multiple donors. Typically increases platelet count by 5,000–10,000/µL in a 70 kg adult.
• Single Donor Platelet Concentrates (SDPC): Collected from one donor using an apheresis machine. A single unit can raise platelet count by 30,000–70,000/µL and is equivalent to 6–8 pooled units.

C) Splenectomy

This surgical removal of the spleen is considered when medications do not effectively raise platelet levels. It is mainly used in immune-related thrombocytopenia. More than half of the patients undergoing splenectomy for ITP experience sustained improvement in platelet counts.

Severe forms of thrombocytopenia heighten the risk of internal bleeding, including in vital areas like the brain or digestive system. Such bleeding is a medical emergency. Warning signs may include:

• Presence of blood in urine
• Tarry, black, or red stools
• Intense headaches
• Neurological symptoms (suggesting potential brain bleeding)

Hemorrhagic shock is another severe complication.

If a splenectomy is recommended, vaccinations are typically given to help ward off infections, since the spleen plays a critical role in immune defense. After removal, patients are more vulnerable to infections. Other post-surgery concerns include clot formation and internal bleeding.

In mild to moderate cases, diet and supplements may assist in raising platelet levels. However, always consult your doctor before starting any supplements, as they may interfere with your current treatment.

• Vitamin C: Boosts platelet function and helps iron absorption. Found in pineapples, mangoes, broccoli, tomatoes, and cauliflower.
• Iron: Essential for healthy blood cell production. Rich sources include mussels, beef, lentils, and pumpkin seeds.
• Papaya leaf extract: Shown to improve platelet count in animal studies and some human cases, especially in dengue. Available in juice or pill form.
• Melatonin: Naturally occurring in the body, mainly used to improve sleep. Supplement forms may also enhance platelet levels.
• Vitamin B12: Deficiency is linked to low platelet count. Found in animal-based foods like beef liver, clams, eggs, and dairy. However, cow’s milk might interfere with platelet production in certain cases.

If you're managing a low platelet count with medication, it’s important to take your prescriptions consistently. Label your medication and set daily reminders to ensure timely intake. Be sure to follow all guidelines provided by your healthcare provider.

Your doctor may advise routine checks of your skin to identify any new bruises, cuts, or abrasions.

To prevent injury, use an electric razor for shaving and opt for a soft toothbrush or mouthwash instead of brushing vigorously.

Keep your nails short to avoid accidental scratching.

If constipation is a concern, talk to your doctor about using stool softeners. Straining during bowel movements can increase pressure in the brain, possibly leading to bleeding.

Post-splenectomy, it’s essential to closely follow your doctor’s recovery instructions and keep an eye on your overall health.

Note: Nosebleeds are common in individuals with low platelet levels. When this happens, lean forward and bend your head down to avoid swallowing blood or obstructing your airway.

If you’ve been diagnosed with mild to moderate thrombocytopenia, regular monitoring may be sufficient. Often, the condition improves once the root cause is addressed. More serious cases may require targeted treatment, and your doctor will create a plan tailored to your needs.

Monitor for bruising or injury

After any physical activity, inspect your body for signs of injury. High-risk sports such as boxing, martial arts, or football should be avoided due to the potential for serious bleeding.

Limit alcohol intake

Alcohol suppresses platelet production. Speak to your doctor to determine how much—if any—alcohol is safe for you. Avoiding alcohol may help maintain healthier platelet levels.

Be cautious with over-the-counter painkillers

Drugs like ibuprofen and aspirin can lower platelet counts or hinder their function. Always check with your healthcare provider before taking any non-prescription medications.

Use a humidifier

Running a cool-mist humidifier at home may help prevent nosebleeds and minimize coughing. This can reduce the risk of pressure-related bleeding, especially in the brain.

Wear medical identification

Having a medical ID bracelet or card that indicates your low platelet status can be vital in emergencies and ensures appropriate care.