How I diagnose and treat neonatal thrombocytopenia

Red Blood Cells 'Talk' To Platelets, With Implications For Diabetes

Amid growing indications that the traditional image of red blood cells (RBCs) falls short of reality, chemists are reporting evidence that RBCs are key participants in a communication system among cells in the bloodstream.

Messaging between RBCs and platelets (blood components that cause clotting) they say, could explain the effects of a drug suggested for use in preventing heart attacks and other complications of diabetes.

In a study scheduled for the July 13 issue of ACS' Analytical Chemistry, a semi-monthly journal, Dana Spence and colleagues note that RBCs once were regarded mainly as oxygen carriers. Recent research, however, shows that red cells also release ATP, a molecule that is the source of energy for all life processes, as they deform while they travel through small blood vessels.

By observing blood flow through artificial blood vessels in laboratory experiments, Spence's group now has established that the ATP signals blood platelets to produce nitric oxide (NO). That messenger molecule has a variety of functions, including dilating blood vessels. When released from platelets, NO helps regulate platelets' activity, preventing excessive clotting. Disruption of the RBC-platelet communications system may play a role in diabetic complications such as heart disease and strokes, the researchers said.

The new study also found that Trental, reported to have beneficial effects in preventing certain diabetic complications, may work by boosting ATP release from red blood cells.

Gestational Thrombocytopenia: Causes, Symptoms, Treatment

Gestational thrombocytopenia (low platelet count) is common during pregnancy and usually doesn't cause complications. But there could be other causes of thrombocytopenia during pregnancy that may require treatment.

If you have thrombocytopenia, it means your platelet count is low. Platelets are blood components that help with clotting.

A decrease in platelet levels is common during pregnancy. This condition, known as gestational thrombocytopenia (GT), is often mild and doesn't cause complications.

This article explores the causes, diagnosis, and treatment of low platelets during pregnancy.

GT is fairly common during pregnancy. For example, the authors of a 2021 study found that GT occurred in 12% of the 3,691 pregnancies included in the study. The authors also cited previous research indicating that GT affects approximately 10% of all pregnancies, which amounts to around 10 million pregnancies globally each year.

Although what precisely causes GT is unknown, it's likely due to typical physiological changes that occur during pregnancy to accommodate a developing fetus.

According to a 2017 review of scientific literature, the total volume of blood circulating in your body increases by 30–50% during pregnancy. As a result, your blood is more diluted than usual. This can lower your platelet count. The authors of a 2022 research review concur, noting that pregnant people tend to have lower platelet counts, on average, than the general population.

It's unclear why some pregnant people develop GT, while others do not.

What else can cause thrombocytopenia in pregnancy?

According to research summarized in the 2022 research review above, around 75% of pregnant people who experience thrombocytopenia have GT. The remaining cases could be a side effect of another condition that may or may not be linked to pregnancy.

Other causes of thrombocytopenia in pregnancy include:

There's no specific diagnostic test for GT. While a complete blood count (CBC) can identify platelet levels that fall below the threshold for thrombocytopenia, it does not explain the cause.

To diagnose GT, your doctor will rule out other potential causes of thrombocytopenia during pregnancy by asking about your symptoms, medical history, and family history. They'll also conduct a physical examination.

Besides a CBC and a blood smear, your doctor might order other tests to check for an infection or evaluate your liver function.

As described above, GT is likely due to physiological changes that naturally occur during pregnancy.

ITP is another potential cause of low platelet counts in pregnant people. Although it is not linked to pregnancy, doctors sometimes accidentally discover it during routine checkups.

Like GT, ITP doesn't always cause symptoms. And when symptoms do occur, they can resemble those of GT.

The following key differences allow doctors to tell the two conditions apart:

Treatment isn't usually necessary for GT. Your doctor will likely continue monitoring your platelet levels every 2–4 weeks as your pregnancy progresses.

Most people who have GT can have a vaginal birth. But if your platelet count is below 20,000 per microliter, your obstetrician might recommend avoiding instruments such as vacuums and forceps during delivery.

Thrombocytopenia usually goes away on its own within 6 weeks of delivery. If you become pregnant again, though, you'll be at an increased risk of developing GT.

Mild thrombocytopenia is common during pregnancy. Most of the time, it doesn't cause symptoms or complications for the birthing parent or baby.

GT doesn't usually require treatment, and it shouldn't change much about your birth plan. Still, your doctor might recommend additional monitoring of your platelet count, particularly in the third trimester.

Low Blood Platelets Call For The Help Of A Hematologist

Published 12:39 pm Monday, July 18, 2022

Q: My brother has low blood platelets and anemia. He will be 73 this year and has had three back surgeries. What causes low blood platelets? Can anything be done to raise platelet count? He drinks alcohol everyday — not hard liquor, but canned alcoholic mixed drinks. He is in constant pain from his back. Also, he has osteoporosis. We have told him to stop drinking, but he won't or can't. What, if anything, can be done for him?

Can I donate my platelets? I have donated many times to the Red Cross. — N.K.

A: There are many causes of low blood platelets. But for low blood platelets in combination with anemia, the list is considerably narrower if the low platelets and anemia have the same cause. Only a thorough evaluation by an expert, such as a hematologist, can answer your question with any certainty.

Alcohol of any type does affect the bone marrow and is one of the more common causes of low platelets and anemia. A trial off of alcohol to see the effect on the blood and platelet levels would be a very wise idea.

People who can't or won't stop drinking, especially when it may be adversely affecting their health, need help. His regular doctor would be a good person to help find ways for him to cut down or quit, but he may also benefit from an expert, such as an addiction specialist. There are also many resources in the community to help people cut down drinking. I wonder if his chronic back pain is one reason he is drinking; if so, better control of the pain might make it easier to quit alcohol.

Donating platelets is a community service, just as donating blood is. Platelets are often in higher demand. Most people outside the hospital with low platelets do not need transfusion, so you may not be helping your brother directly, but you will be helping people with cancer and other serious diseases.

Q: My friend is diabetic and had to have foot surgery after cutting their own toenails. Why is this so dangerous? — T.S.B.

A: People with diabetes should know that they ought not to cut their own toenails — even a small nick can lead to an infection. Longstanding diabetes puts a person at risk for poor blood flow from both large and small blood vessels and decreased immune function. Diabetics may have poor sensation, which is necessary to let them know there is a developing problem.

Unfortunately, it is all too common that people ignore the advice and try to take care of their feet themselves. Compounding this, they often don't do daily foot exams, like they're supposed to. These checks are meant to make them aware of any infection so that it can be treated before it gets too dangerous.

Sometimes, by the time the foot infection needs medical attention, it can be very serious, potentially requiring amputation.

Risk of this is lowered by better diabetes control to prevent the blood vessel and nerve disease, with proper professional foot care by a podiatrist and with daily foot exams by the person with diabetes.

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