Thrombocytopenia

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What is thrombocytopenia?

Thrombocytopenia is a disorder in which there are too few platelets in the blood. Platelets are small, disk-shaped cellular structures in the bloodstream that help the blood to clot. Thus, thrombocytopenia is often characterized by excessive bleeding, including nosebleeds and easy bruising. Thrombocytopenia can be diagnosed by a routine blood test.

Thrombocytopenia arises for one of three reasons: the bone marrow may not produce enough platelets; too many platelets may be broken down in the blood; or too many platelets may be destroyed in the liver or spleen. Thrombocytopenia can be caused by a variety of conditions or medications.

Thrombocytopenia can occur as a complication of diseases such as leukemia or HIV (human immunodeficiency virus) infection. It may also be related to the use of certain medications. In some cases, too many platelets are trapped and stored in the spleen (an organ in the abdomen that is responsible for filtering the blood), leaving too few platelets in circulation.

Treatment of thrombocytopenia depends on the type and cause of platelet deficiency. In severe cases, platelet transfusions may be required. Similarly, the outcome and complications of thrombocytopenia also depend on the type and cause of the disorder.

Emergency attention should be obtained if you have any unexplained or unusual bleeding or bruising, which may indicate a life-threatening case of thrombocytopenia. Seek immediate medical care (call 911) if you have serious symptoms, such as excessive or uncontrollable bleeding and unexplained bruising.

What are the symptoms of thrombocytopenia?

Mild cases of thrombocytopenia may not produce any symptoms. The symptoms of moderate thrombocytopenia are related to problems in blood clotting, such as frequent or easy bruising or bleeding, nosebleeds, bleeding gums, or a rash. In severe cases, unexplained bruising or bleeding may occur, including bleeding in the brain or in other internal organs.

Common symptoms of thrombocytopenia

You may experience thrombocytopenia symptoms daily or just once in a while. At times, any of these symptoms can be severe:

  • Bleeding of the gums
  • Delay in cessation of active bleeding
  • Nosebleeds
  • Rash (petechiae, or red, pinprick-sized spots on the skin)
  • Skin discoloration such as bruising

Serious symptoms that might indicate a life-threatening condition

In some cases, thrombocytopenia can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these potentially life-threatening symptoms including:

  • Severe or uncontrollable bleeding
  • Unexplained bleeding
  • Unexplained bruising

What causes thrombocytopenia?

Thrombocytopenia, or a low level of platelets in the blood, can arise from a variety of diseases, disorders or conditions that cause either low platelet production or excessive platelet breakdown. Platelet breakdown can occur in the bloodstream, liver or spleen.

Causes of low platelet production

Thrombocytopenia can result from conditions that affect the bone marrow and disrupt the production of platelets from bone marrow stem cells including:

  • Anemia (low red blood cell count)

  • Bone marrow cancer

  • Bone marrow infection

  • Chemotherapy

  • Cirrhosis of the liver

  • Medication side effects

  • Myelodysplasia (low production of certain types of blood cells)

  • Vitamin B12 or folate deficiency (as in pernicious anemia)

Causes of platelet breakdown in the bloodstream, liver and spleen

Thrombocytopenia may also result from conditions that lead to the excessive breakdown of blood cells in the bloodstream, liver and spleen including:

  • Disseminated intravascular coagulation (DIC)

  • Hemolytic uremic syndrome (rare disease characterized by kidney failure and multiple blood clots)

  • Hypersplenism (overactive spleen)

  • Immune- and nonimmune-induced breakdown of blood cells

  • Immune thrombocytopenic purpura and thrombotic thrombocytopenic purpura (rare conditions in which small blood clots form throughout the body, resulting in low platelet levels)

  • Medication side effects

What are the risk factors for thrombocytopenia?

A number of factors increase the risk of developing thrombocytopenia. Not all people with risk factors will get thrombocytopenia. Risk factors for thrombocytopenia include:

  • Anemia (low red blood cell count)

  • Certain types of cancer such as leukemia (cancer of the blood or bone marrow)

  • Certain viral or bacterial infections

  • Chemical or environmental toxin exposure

  • Family history of low platelet counts

  • HIV/AIDS

  • Pregnancy

  • Use of oral contraceptives

Reducing your risk of thrombocytopenia

Your risk of developing thrombocytopenia depends on the underlying cause. Although it is generally not possible to prevent thrombocytopenia, in certain cases you may be able to lower your risk of thrombocytopenia by:

  • Avoiding alcohol, which slows platelet production

  • Avoiding environmental toxins, which can reduce platelet production

  • Avoiding medications known to decrease platelet production

  • Receiving vaccinations as recommended by medical professionals

How is thrombocytopenia treated?

In mild cases of thrombocytopenia, no treatment may be required. For moderate cases, treatment depends on the cause of thrombocytopenia. In cases related to medications or environmental contaminants, thrombocytopenia may resolve on its own once the underlying cause is removed. In other moderate cases, medication may be prescribed in order to increase platelet counts. In severe thrombocytopenia, procedures such as blood transfusion, platelet transfusion, or splenectomy (surgical removal of the spleen) may be necessary.

Medications for low platelet counts

Low platelet counts may treated with medications designed to increase platelet production or decrease platelet breakdown including:

  • Corticosteroids, such as prednisone, to prevent platelet breakdown
  • Immunoglobulins to boost platelet production
  • Romiplostim (Nplate) or similar medications to increase platelet production

Treatments for severe thrombocytopenia

Severe or life-threatening thrombocytopenia that does not respond to medication may require additional types of treatment including:

  • Blood transfusions to replenish blood lost through excessive bleeding
  • Platelet transfusions to boost platelet counts
  • Biologic infusion (Rituximab) if corticosteroids fail to work, or if splenectomy is not possible
  • Splenectomy (surgical removal of the spleen) to prevent excessive platelet breakdown

What are the potential complications of thrombocytopenia?

Although mild thrombocytopenia may have no apparent symptoms and does not interfere with normal life, severe thrombocytopenia can have acute, life-threatening complications if not treated promptly. These complications are generally due to excessive bleeding. Long-term complications of untreated thrombocytopenia can be serious, even life threatening in some cases.

You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of thrombocytopenia include:

  • Adverse effects of treatment
  • Anemia
  • Excessive or uncontrollable bleeding
  • Gastrointestinal bleeding
  • Intracerebral hemorrhage (bleeding in the brain) 
  • Severe nosebleeds
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jan 18
  1. Thrombocytopenia. MedlinePlus, U.S. National Library of Medicine. https://medlineplus.gov/ency/article/000586.htm
  2. Explore Thrombocytopenia. National Institutes of Health. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health/health-topics/topics/thcp/
  3. Dowling MR, Josefsson EC, Henley KJ, et al. Platelet senescence is regulated by an internal timer, not damage inflicted by hits. Blood 2010; 116:1776.
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