Thrombocytopenia is when you don't have enough platelets, cells in your blood that stick together to help it clot. Sometimes, the condition doesn’t cause any problems at all. But if you have symptoms like too much bleeding, treatment can help.
Your bone marrow, the spongy tissue inside your bones, makes platelets. You can get thrombocytopenia if your body doesn't make enough of them or if it destroys them faster than you can replace them.
Your body might not make enough platelets if you:
- Have a blood disorder that affects your bone marrow, called aplastic anemia
- Have cancer such as leukemia or lymphoma, which damages your bone marrow
- Have a platelet-lowering disease like Wiskott-Aldrich or May-Hegglin syndromes
- Have a virus such as chickenpox, mumps, rubella, HIV, or Epstein-Barr
- Drink a lot of alcohol over a long time
- Have chemotherapy or radiation treatment for cancer, which destroys stem cells that form platelets. If you've had contact with chemicals like pesticides and arsenic, your body might slow the process of making platelets.
Your body can destroy too many platelets because of:
- Autoimmune diseases such as lupus, immune thrombocytopenia, or idiopathic thrombocytopenic purpura (ITP), in which your body attacks healthy cells
- Bacteria in your blood, also known as bacteremia
- Medicines, like antibiotics that contain sulfa, heparin to prevent blood clots, and anti-seizure drugs such as phenytoin (Dilantin) and vancomycin (Vancocin)
- Rare diseases that make blood clots form, such as thrombotic thrombocytopenic purpura (TTP) and disseminated intravascular coagulation (DIC)
- Hemolytic uremic syndrome, a rare disorder that also destroys red blood cells and causes kidney problems
- 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.
Sometimes, you don't have any symptoms from thrombocytopenia. When you do, the main problem is bruising and bleeding in your skin that looks like tiny red or purple spots, called petechiae.
You can bleed outside or inside your body. Sometimes, it can be heavy or hard to stop.
You might also have:
- Bleeding from your gums or nose
- Blood in your urine or poop
- Heavy menstrual periods
- Yellow skin or eyes (jaundice)
- A swollen spleen
These symptoms might not start until your platelet count is very low. Tell your doctor about them right away.
Your doctor will ask about your medical history and symptoms. They’ll look for bruises, petechiae, and other signs of low platelets. They’ll also check for signs of infection, like a fever or rash.
You might have a blood test that measures how many platelets you have. Most people have 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:
- A blood smear to look at your platelets under a microscope and see how healthy they are
- A bone marrow test to see what cells are in the marrow, how full the marrow is with cells, and whether they are normal
- Tests to check that your blood clots the way it should
When your platelet count falls below 50,000, you might have especially heavy bleeding after an injury. Below 30,000, even a minor injury may cause a lot of bleeding.
If your platelet count falls below 10,000, you can have dangerous internal bleeding without an injury. Rarely, you may also have life-threatening bleeding in your brain.
If your platelet count isn't too low, you might not need treatment.
Sometimes, your platelet count will go up when you avoid the cause of the problem. For instance, if a certain medicine is behind your thrombocytopenia, your doctor will probably have you stop taking that drug.
For severe thrombocytopenia, your doctor might give you:
- Steroid medicines to keep your body from destroying platelets if the problem is related to your immune system
- Intravenous immune globulin (IVIG) if you can’t take steroids or if you need a higher platelet count quickly
- Blood or platelets from a healthy person, called a transfusion
- Surgery to remove your spleen
If your condition continues despite other treatments, your doctor may prescribe medicines such as eltrombopag (Promacta, Revolade), fostamatinib (Tavalisse), and romiplostim (Nplate).
To prevent bleeding when your platelet count is low:
- Don’t take medicines that can affect how well your platelets work, like aspirin and ibuprofen.
- Limit how much alcohol you drink, because it can make bleeding worse.
- Don't take part in contact sports, like football or boxing, in which you might get injured.
- Use a soft toothbrush to protect your gums.
- Wear a seatbelt when you’re in a car, and put on gloves and goggles when you work with power tools to prevent injury.