Thrombocytopenia

Thrombocytopenia means you don't have enough platelets, cells in your blood that stick together to help it clot. It might not cause you any health problems at all. But if you do have symptoms like bleeding too much, treatments can help.

Causes

Platelets are made in your bone marrow, the spongy tissue inside your bones. You can get thrombocytopenia if your body doesn't make enough of them, or if they're destroyed faster than they can be made.

Your body might not make enough platelets if you have a:

  • Blood disorder that affects bone marrow, called aplastic anemia
  • Cancer such as leukemia or lymphoma, which damages your bone marrow
  • Platelet-lowering disease that runs in your family, like Wiskott-Aldrich or May-Hegglin syndrome
  • Virus such as chickenpox, mumps, rubella, HIV, or Epstein-Barr
  • Aplastic anemia
  • Chemotherapy or radiation treatment for cancer destroys stem cells that form platelets. If you've been in contact with chemicals like pesticides and arsenic, your body might slow down the process of making platelets.

Your body can destroy too many platelets by:

  • Autoimmune diseases such as lupus or idiopathic thrombocytopenic purpura (ITP), where your own body attacks healthy cells
  • Medicines, such as antibiotics that contain sulfa, heparin used to prevent blood clots, and antiseizure drugs such as phenytoin (Dilantin) and vancomycin (Vancocin)
  • Rare diseases that make blood clots form in the body, such as thrombotic thrombocytopenic purpura (TTP) and disseminated intravascular coagulation (DIC)
  • Viruses like Epstein-Barr virus (EBV), hepatitis C, and HIV

Sometimes, you don't have enough platelets because they get trapped in your spleen, an organ that fights infection. And women may get thrombocytopenia during pregnancy, because their bodies get rid of platelets more quickly than usual.

Symptoms

Sometimes you don't have any symptoms from thrombocytopenia. When you do, the main one is bleeding in the skin that look like tiny red or purple spots on the skin, called petechiae, or bruising.

You can bleed outside or inside your body. Sometimes it can be heavy or hard to stop. Some people get nosebleeds or bleeding gums.

You might also have:

These symptoms might not start until your platelet count is very low. If you notice any of them, call your doctor.

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Diagnosis

Your doctor will ask questions about your medical history and symptoms. You'll also get an exam to look for bruises, petechiae or spots of blood in your skin, and other signs of low platelets. You'll be checked for signs of infection, like a fever or rash.

You might get a blood test that measures the number of platelets. A normal count is 150,000 to 450,000 platelets per microliter of blood. You can have bleeding problems if your count drops below 50,000.

Your doctor will most likely consult with a blood specialist (hematologist). You might get other tests, including:

  • Blood smear to look at your platelets under a microscope and see how healthy they are
  • Bone marrow test to see what cells are in the bone marrow, how full the bone marrow is with cells, and whether they are normall

Your doctor might want you to take other tests that check if your blood clots normally.

Treatment

If your platelet count isn't too low, you might not need treatment. You won't bleed too much, even if you get cut.

Sometimes your platelet count will go up when you avoid the cause of the problem. For instance, if taking a certain medicine is behind your thrombocytopenia, your doctor will have you stop that drug.

For severe thrombocytopenia, you might get:

  • Steroid medicines to stop your body from destroying platelets if the cause is related to your immune system.
  • Blood or platelets from a healthy person, called a transfusion
  • Surgery to remove your spleen

If your condition is ongoing despite other treatments, your doctor may prescribe medicines such as romiplostim (Nplate) and eltrombopag (Promacta, Revolade). A new medicine called fostamatrinib (Tavalisse) may be another option.

To prevent bleeding when your platelets are low:

  • Avoid medicines that can affect your platelet function, like aspirin and ibuprofen
  • Limit how much alcohol you drink, because it can make bleeding worse.
  • Don't play contact sports, like football or boxing, where you might get injured.
  • Use a soft toothbrush to prevent bleeding gums.
  • Wear a seatbelt in the car, and put on gloves and goggles when you work with power tools to prevent injury.
WebMD Medical Reference Reviewed by Louise Chang, MD on August 16, 2018

Sources

SOURCES:

American Family Physician: "Thrombocytopenia."

American Society of Clinical Oncologists: "Thrombocytopenia."

Cleveland Clinic: "Thrombocytopenia."

National Heart, Lung, and Blood Institute: "Thrombocytopenia"

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