Thrombocytopenia Causes Symptoms Treatments

What is Thrombocytopenia?

Thrombocytopenia is a blood disorder or a disease of blood which means there are insufficient number of platelets counts in blood. Platelets are colorless small blood cells that help in blood clotting to stop bleeding.

Thrombocytopenia may occur in both adults and children who have bone marrow disorder. Where bone marrow disorder includes leukemia and auto-immune disease. It also may happen as a result of taking certain medicine that impedes bone marrow to produce blood cells.  

There are three types of thrombocytopenia depending on platelets count, mild, moderate and severe. If platelets count is less than 150,000 to 100,000 it is called mild thrombocytopenia. And if platelets count is less than 100,000 to 50,000 it is called moderate and less than 10,000 is severe thrombocytopenia.

What are the causes of thrombocytopenia?

There is no specific reason for thrombocytopenia. It can happen for a few reasons, the main is autoimmune disease. As we know thrombocytopenia is related to lower platelet count, we should know that each platelet lives approximately 10 days. And if there are less than 150,000 platelets per microliter, blood is counted as thrombocytopenia. In medical research it was found that only 3 or 4 persons among 1000 are diagnosed with thrombocytopenia.

Spleen traps platelets

Spleen is a small organ under the rib in the left side of the abdomen. Normally, the spleen works to defend infections and filter unwanted substances from your blood. In general, the spleen keeps 1/3 of your platelets when it filters and circulates the blood cells. But when it stores platelets more than it should do then platelets deficiency occur in the blood cells. That causes thrombocytopenia.

Deficiency in platelets production

Bone marrow produces platelets, sometimes it can not produce platelets because of some reasons which are below

• Chemotherapy drugs and radiation therapy impede bone marrow to produce blood.
• If you consume excessive alcohol for a long time, that might reduce the ability of bone marrow to produce enough platelets.
• Infection as a result of virus attack, and certain types of anemia.
• Leukemia and other types of blood cancers also may reduce the ability of bone marrow to produce platelets.

Platelets Breakdown

Platelet breakdown means reduction of the existence of platelets in the blood. There are some factors that cause platelet breakdown

• Pregnancy can cause platelet breakdown till child birth.
• Autoimmune diseases such as lupus, where the immune system attacks its own tissue and rheumatoid arthritis can cause immune thrombocytopenia. In this case, immune system mistakenly attacks itself and destroy platelets in blood. This is known as immune thrombocytopenia purpura (ITP) and it is more often seen in children.
• Infection by bacteria may cause platelet breakdown.
• Hemolytic uremic syndrome, a rare disorder responsible for sharp platelets drop and impairs kidney function.
• Thrombotic thrombocytopenic purpura (TTP) is another reason for platelets destruction. In this case small blood clots form up throughout the body using a large number of platelets.

Besides this, blood clots in lungs, and high blood pressure in lungs can cause thrombocytopenia.

Complications

In general, a healthy person has 150,000 to 4,50,000 platelets per microliter blood. A single drop of blood has 35 microliters. If you have platelets less than 150,000 it will be counted as lower platelets. But if it goes down to 10,000 platelets per microliter you may face severe internal bleeding. For that you might have blood vomiting, blood with urine, blood through nose and stool.

What are the symptoms of thrombocytopenia?

Thrombocytopenia may occur without any symptoms. A mild thrombocytopenia can be found when a complete blood count test is done. There are some symptoms for moderate to severe thrombocytopenia as below.

• Long term bleeding from any kind of cuts, scraps or injuries.
• Nose bleeding, blood with urine, blood through stool, heavy menstrual bleeding.
• Easy or excessive bruising that does not stop for a long period.
• Petechiae ( bleeding spot into the skin that appears as a rash usually in lower legs).
• Fatigue
• Enlarged spleen which contains more platelets than it should.

What are the types of thrombocytopenia?

Depending on low platelets count you can have different types of thrombocytopenia which are described below.

Immune thrombocytopenia Purpura

Immune thrombocytopenia purpura  is the most common type of thrombocytopenia. It may occur in children or adults. “Purpura” is a purple rash on the skin that looks like bruising. There are two types of ITP, acute and chronic. Acute thrombocytopenia is most common in children, like chicken pox. And it gets well within a week or a month. Where chronic thrombocytopenia is most common in adults. It takes months to years to recover. Though there might not be any necessity to treat acute thrombocytopenia. On the other hand chronic thrombocytopenia needs proper medication and treatment. The old name of immune thrombocytopenia purpura is idiopathic thrombocytopenic purpura.

Thrombotic thrombocytopenic purpura

This is a rare type but more dangerous than other types of thrombocytopenia. In this type of thrombocytopenia you will get many unusual blood clots throughout your body. As a result you will not have enough platelets in your blood that may cause internal bleeding, damage of your vital organs and may lead to death. Lethal condition like stroke or heart attack may occur due to lack of platelets. It may last for a week, month or even a year. You will need proper treatment, medication, and maintenance to get recovery from this type of thrombocytopenia.

Thrombocytopenia caused by medicines 

There are about 300 medicines that may cause thrombocytopenia. You will be noticing thrombocytopenia after taking these drugs for one or two weeks. But it will go away when you stop taking these drugs.

Distributional thrombocytopenia

Your spleen stores 30% of your total platelets when blood circulates throughout the body. But when the spleen stores more than it should, it is called distributional thrombocytopenia. In this case, the spleen may store 90% of your total platelets. Proper treatment is necessary for this type of thrombocytopenia.

Delusional thrombocytopenia

When a major blood transfusion happens to replace more blood you have in 24 hours then for an instance you may have lower platelets count. Because your old blood got replaced by new red blood cells. In this case your doctor will decide what step should be taken.

Heparin Induced thrombocytopenia

When you are at risk of a dangerous clot due to a major surgery in the hospital. Then doctors use heparin (a medicine used to protect against blood clotting after surgery) to stop blood clotting. After 2 or 3 days of using heparin, your platelets may fall due to severe blood clots. This type of thrombocytopenia is known as heparin induced thrombocytopenia.

Gestational thrombocytopenia

Pregnant women get mild thrombocytopenia during pregnancy. And it goes away after child birth. Yet it is not confirmed why thrombocytopenia occurs during pregnancy, but it is common. It may come back again in the next pregnancy. If you once had thrombocytopenia during pregnancy.

What are the diagnosis and tests for thrombocytopenia?

Unless you diagnose your blood and any symptoms are not shown in your body. It is hard to say that you have thrombocytopenia. In a mild case, thrombocytopenia is diagnosed through a complete blood count(CBC) test. Doctors will do some physical examination to know whether you have thrombocytopenia or not.

Blood test

A complete blood count (CBC) test will be performed to know your red, white blood cells and number of platelets in your blood. If there are less than 150,000 platelets in your blood it will be counted as mild thrombocytopenia.

Blood smear

When a doctor examines blood under a microscope to determine the number of platelets, it is called blood smear.

Bone marrow examination

Bone marrow produces new blood cells, if it does not produce enough platelets there will be a lack of platelets in the blood. Doctors will examine liquid from your bone marrow with a very fine needle to see if it produces enough blood cells or not. This procedure is known as bone marrow biopsy.

Platelets antibody test

In this procedure, doctors will check if your blood has platelet antibodies. This happens in ITP where the immune system works against platelets and reduces the number of platelets.

Blood clot test

Doctors perform blood clots tests to see if your body is using an irregular number of platelets to complete a clot procedure. Which is responsible for lower platelets count.

Medical history and family background checkup

Without the above tests, doctors may check your previous medical history to see if you were attacked by autoimmune disease. If you had any serious injury that caused loss of a lot of blood. Medicines you have taken previously and recently. And if any of your family members had autoimmune disease or thrombocytopenia.

What are the risk factors of thrombocytopenia?

There are some risk factors for thrombocytopenia as below. Remember these factors if you doubt you have thrombocytopenia or not and warn others about that.

• Medicines like heparin, quinine, and anti-seizure drugs destroy or slow down the natural speed of platelets production. So you must consult with your doctor before taking any of the above medicines.
• Alcohol is toxic to bone marrow, It impedes bone marrow in producing new blood cells. So consuming an excessive amount of alcohol may lead to lower platelet count.
• Arsenic, benzene, and pesticides are toxic to bone marrow. It impedes bone marrow to produce platelets.
• Blood cancer, leukemia and lymphoma destroy bone marrow. Then without any treatment it becomes unable to produce platelets.
• Aplastic anemia reduces the number of blood cells that cause lower platelets count.
• In autoimmune conditions the immune system destroys blood cells and works as platelets antibodies. 
• Surgery causes loss of a lot of blood that may cause lower platelets count in post surgery.
• Enlarged spleen stores more platelets than it should do that causes reduction of platelets in blood cells. 
• Sometimes virus and bacterial infection can cause reduction in platelets count.

What treatment options are available for thrombocytopenia?

Without any symptoms thrombocytopenia may not need treatment. But if doctors want they can suggest some medicine to get rid of. If your thrombocytopenia is mild you may not need any treatment it will be gone within a few days or a month. If your thrombocytopenia is from ITP then you have to work with your immune system. And for drug induced thrombocytopenia you may stop taking drugs associated with thrombocytopenia. There are some treatment for thrombocytopenia like

Blood transfusion

If your platelets count is low your doctor may replace the lost platelets with red blood cells or platelets from another person.

Medication or targeted therapy

Specific medication or targeted therapy can boost your platelet level instance. Targeted therapy like Avalet, Elopag and Elbonix are used to boost platelet count if patients are diagnosed with bone marrow problems or other diseases.

Surgery

If targeted therapy or medicines do not work, and thrombocytopenia happens because of an enlarged spleen. Doctors may suggest removing your spleen. On the other hand if your thrombocytopenia happens in association with bone marrow problem. Doctors may suggest replacing your bone marrow.

Plasma exchange

In the case of thrombotic thrombopoietic purpura plasma exchange can be a good treatment option if doctors suggest.

How to prevent thrombocytopenia?

You can not prevent thrombocytopenia fully if it is genetic or related with autoimmune system disease. In this case you may continue treatment consulting your doctor to reduce the effects of this disease. But you can follow some basic instructions to prevent thrombocytopenia.

• Do not consume much alcohol if you want to prevent thrombocytopenia. Because alcohol is toxic to bone marrow and hinders platelets production.
• Avoid cuts and injuries that cause severe bleeding if you have thrombocytopenia you may won’t be able to stop bleeding after cuts or injuries that make you bleed.
• If your autoimmune disease like thrombocytopenia comes from your family members then you may won’t be able to stop this. But you can manage your thrombocytopenia with proper lifestyle, medicines and treatment.
• Avoid medicines that cause lower platelets count like heparin and quinine.
• Eat enough foods that make red blood cells if you doubt you may have thrombocytopenia.

Conclusion

Thrombocytopenia is not a lethal disease at all. It can be prevented by proper cautions. Proper treatment and maintained lifestyle may prevent thrombocytopenia.

References

https://www.mayoclinic.org

https://www.webmd.com

https://www.healthline.com

https://my.clevelandclinic.org