Low Platelet Count Thrombocytopenia

By Dr. Balkrishna Padate in Hemato-Oncology & Bone Marrow Transplant

Apr 24 , 2023 | 1 min read

Introduction

Platelets are one of the cells in the blood and are produced in the bone marrow. Blood is composed of two components, plasma (fluid component) and cells (cellular component). There are three types of cells in blood - red blood cells, white blood cells and platelets. A normal human platelet count ranges from 150,000 to 450,000 platelets per microliter of blood.

Signs and Symptoms

Often, mild reduction in platelet count (platelet count less than normal but > 30 000) does not lead to clinical problems; rather, they are picked up on a routine complete blood count (CBC). Occasionally, there may be bluish reddish patches on the skin (bruising), pinpoint bleeding on the skin, nosebleeds and/or bleeding gums.

It is vital to ensure that the low platelet count is not associated with a reduction in other blood cells like red blood cells and white blood cells. Also the acute secondary causes like malaria, dengue must be ruled out.

Common causes of low platelet counts are

Infections such as malaria and dengue
Deficiencies of vitamins such as Vitamin B12 and Folic Acid
Medicine toxicity such as chemotherapy drugs
Reduced production from bone marrow in patients with leukaemia, aplastic anaemia etc.
Reduced production from bone marrow in patients with leukaemia, aplastic anaemia etc.

A person with a low platelet count may also complain of malaise, fatigue and general weakness (with or without accompanying blood loss). A platelet count of <30,000 can be dangerous with a risk of serious bleeding particularly in elderly people. The risk of bleeding is compounded if the patient is also on anti-platelets and blood thinners.

Diagnosis

Laboratory tests include: full blood count, liver enzymes, renal function, Vitamin B12 levels, Folic Acid levels and peripheral blood smear. If the cause for the low platelet count remains unclear, a bone marrow biopsy is usually recommended to differentiate whether the low platelet count is due to decreased production or peripheral destruction in the blood. Bone marrow examination also rules out other bone marrow conditions at the same time.

Treatment

Treatment is guided by cause and severity. The main concept in treating Thrombocytopenia is to eliminate the underlying problem and to transfuse platelet to avoid bleeding, if necessary.

There are several medicines used to increase platelet production. Steroids are common amongst them. Vitamin B12 and folic acid supplements are given in deficient patients to stimulate the bone marrow production of platelets. Platelet transfusions may be used to stop bleeding in severe Thrombocytopenia.

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