How I diagnose and treat neonatal thrombocytopenia
Low Blood Platelets Call For The Help Of A Hematologist
Dr. Keith Roach
DEAR DR. ROACH: 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.
ANSWER: 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.
DEAR DR. ROACH: My friend is diabetic and had to have foot surgery after cutting their own toenails. Why is this so dangerous? — T.S.B.
ANSWER: 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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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.Cornell.Edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
What Causes Thrombocytopenia (low Platelet Count)?
Key takeawaysA reduced platelet count in the blood is not always a serious problem. However, the condition affects the blood's ability to clot. If a person's blood does not clot, a wound may bleed severely. This can have serious complications in some cases.
This article examines the conditions, medications, and substances that can cause a low platelet count. It also outlines how to recognize the symptoms and what to expect from treatment.
A platelet count measures the concentration of platelets in the blood. A normal platelet count is 150,000–450,000 platelets/µl. When the number of platelets is low, this concentration reduces.
A person with thrombocytopenia will have a platelet count below 150,000/µl.
Females usually experience a platelet count that varies slightly during the menstrual cycle and can fall near the end of pregnancy.
Thrombocytopenia may make it difficult for the body to stop bleeding following an injury. Bleeding can occur inside the body, beneath the skin, or at the skin's surface.
People with thrombocytopenia usually do not experience serious bleeding until their platelet count is very low.
Two main factors cause a person to have a low platelet count: an underlying health condition or a medication. These factors can lower the platelet count by affecting the production, storage, use, or destruction of platelets.
Medical conditions that can cause a low platelet count
A low platelet count may occur due to:
Certain medical conditions can also cause a person to have a low platelet count. These include:
Pregnancy can sometimes cause a person to develop mild thrombocytopenia. The exact reason for this is unknown, but it seems to be more common close to delivery.
Medications and substances that can cause a low platelet count
Various substances can cause a person to have a low platelet count, including:
If a substance is causing a person's low platelet count, a doctor may suggest they stop taking it. Doing so should return the platelet count to normal.
If the cause is a drug a person takes for a different condition, the prescribing doctor might change the medication.
Over-the-counter (OTC) medications that can cause a low platelet count include:
Prescription medications that can cause thrombocytopenia include:
Symptoms of a low platelet count only occur at severely low levels. A count that is only slightly lower than normal may not produce symptoms.
If the count is low enough to cause spontaneous bleeding, an individual may notice minor bleeds that create small, round, dark red spots on the skin called petechiae.
Several petechiae can merge to form bruise-like rashes called purpura.
People with immune thrombocytopenia or ITP may also experience bleeding gums, nose, and blood in the urine or stools. In these cases, platelet counts are typically below 20,000/µl.
Platelets are a crucial component of the blood. They are responsible for repairing tissue damage and play a vital role in the blood-clotting system, helping stop bleeding and heal wounds. Blood clotting is also known as hemostasis.
The bone marrow produces platelets, and they are present in the blood and spleen.
How do platelets stop bleeding?
If damage occurs to the wall of a blood vessel, the vessel exposes a substance that activates platelets. Activated platelets trigger further events that bring in more platelets and a blood clot forms. This serves to plug any leak.
Activated platelets also release sticky proteins to help form the clot. A protein known as fibrin forms a mesh of threads that holds the plug together.
To diagnose a low platelet count, a doctor may begin by asking some questions and performing a physical examination. The questions might cover symptoms, family history, and medications. The examination will assess for skin rashes and bruising.
A laboratory platelet count will confirm the diagnosis, showing the exact concentration of platelets in the blood. The doctor is likely to perform other blood tests at the same time.
There are two types of bone marrow tests: a bone marrow aspiration and a bone marrow biopsy. In both tests, a doctor uses a needle to take a sample of the bone marrow for examination. Aspiration involves collecting a small amount of fluid, whereas a biopsy involves collecting some soft tissue.
A doctor may diagnose thrombocytopenia after ruling out other causes of a low platelet count.
Anyone experiencing unusual symptoms or having other concerns should discuss these with a doctor.
Platelets are components of blood cells that play a vital role in forming blood clots. If a person has a low platelet count, called thrombocytopenia, their blood might not clot properly. This can lead to symptoms such as blood loss and bruising.
Causes of a low platelet count include medical conditions and exposure to certain medications and substances, such as alcohol and quinine.
Slightly low platelet counts that do not produce symptoms may not require treatment. However, if symptoms are present, treatment may be necessary.
Treatment can involve switching medications, reducing exposure to certain substances, or treating the underlying medical condition.
Thrombocytopenia In Children: Symptoms, Causes, And Treatments
Thrombocytopenia refers to a low blood platelet count. This can lead to bruising easily or bleeding excessively.
In children, acute immune thrombocytopenia (ITP) is relatively common, and it may develop after a viral illness, such as chickenpox. In other cases, the condition is long lasting. It may stem from the use of medications or a genetic mutation.
If a child has acute ITP, they usually recover within 6 months, and if the condition is mild, they may not need any treatment.
Below, learn more about thrombocytopenia in children.
A low blood platelet count can result from many factors.
Acute ITP
Researchers believe that viruses, such as the one that causes chickenpox, can temporarily alter how a child's immune system behaves and cause it to attack platelets, resulting in acute ITP.
This issue is more common in children 2–6 years old. Usually, the symptoms are mild and go away on their own within 6 months. However, 1 in 5 children with the condition go on to develop chronic ITP.
Chronic ITP
This is rare in young children and is more common in adolescents and adults, particularly in females. It may last for several months or a lifetime and require specialist treatment. In some people, chronic ITP seems to resolve but recurs often.
Drug-induced thrombocytopenia
Thrombocytopenia can develop in response to medication, and this can be life threatening in newborns and other young children.
In a 2019 case study and review, a baby had a severe drop in their platelet count after receiving ranitidine (Zantac) for trouble feeding. Ranitidine can also treat acid reflux.
Fully understanding the effects of ranitidine and similar drugs on the platelet count in babies and young children requires more research.
Infections
Malaria, in particular, can lead to a severe reduction in a child's platelet levels, a 2021 study confirms. The authors suggest that the presence of thrombocytopenia may be a reliable indicator of malaria in children.
MYH9-related thrombocytopenia
This form of thrombocytopenia is distinct because the reduced platelet count results from a genetic mutation, rather than the immune system attacking the body's platelets.
The MYH9 gene is responsible for building proteins that occur in certain blood cells, including platelets. A person can inherit this mutation from their parents or develop it spontaneously.
Several diseases involve a mutation of the MYH9 gene, and all of them can cause thrombocytopenia:
Aplastic anemia
Aplastic anemia is a form of bone marrow failure, and it can cause thrombocytopenia. As the bone marrow shuts down, it produces fewer red and white blood cells and platelets.
In most cases, aplastic anemia develops without any obvious cause, and doctors refer to this as "idiopathic" aplastic anemia. However, some children may inherit the condition or develop it after an infection.
Bone marrow failure tends to occur between the ages of 1 and 5 years or between the ages of 12 and 20 years.
The National Heart, Lung, and Blood Institute explains that doctors consider a person's medical history and the results of a physical examination and tests when diagnosing thrombocytopenia and identifying its cause.
Medical history
A doctor may ask about anything that could affect platelet levels, including:
Physical examination
During this, the doctor checks for signs of bruising and bleeding. They may also look for symptoms of an infection, such as a fever.
Diagnostic tests
If the doctor suspects thrombocytopenia, they run several tests, which may also determine the cause of this issue.
These tests may include:
When a child has thrombocytopenia, the treatment depends on the cause and the severity of the symptoms.
For example, a child with mild acute ITP likely does not need treatment, as this tends to resolve on its own. However, if the child is highly likely to bleed profusely, they may need a blood or platelet transfusion.
A child with chronic ITP that frequently recurs may need medication that suppresses the immune system, such as rituximab. If an infectious illness, such as HIV, is responsible, the doctor may prescribe corticosteroids, which slow platelet destruction.
Overall, the goal of thrombocytopenia treatment is to prevent serious complications. If an underlying health condition is causing the low platelet count, the doctor will focus on treating both issues.
Thrombocytopenia refers to low levels of platelets in the blood, which can increase the risk of bleeding and bruising easily.
Acute ITP is the most common form of thrombocytopenia in children, and it usually resolves on its own within 6 months. Less common causes of thrombocytopenia include medications, infections, and a genetic mutation.
If a child's symptoms are very mild, they may not need treatment. A child with chronic ITP may have a risk of severe bleeding and need immunosuppressant medication.
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