From the Guidelines
Platelet count is significant because it helps assess bleeding risk, clotting ability, and overall health status, with low platelet counts (thrombocytopenia) below 50,000 increasing bleeding risk, and counts under 10,000 potentially causing spontaneous bleeding 1.
Key Points
- Normal platelet counts range from 150,000 to 450,000 platelets per microliter of blood.
- Platelets are crucial for hemostasis, forming plugs at injury sites and releasing chemicals that promote clotting.
- Abnormal counts can indicate various conditions: low counts may suggest bone marrow disorders, immune system problems, medication side effects, or infections, while high counts might indicate inflammation, cancer, or bone marrow disorders.
- Regular monitoring is essential for patients with bleeding disorders, those on anticoagulants, during chemotherapy, or before surgical procedures.
- Platelet count is typically measured as part of a complete blood count (CBC) and helps guide treatment decisions, including when platelet transfusions might be necessary (usually when counts fall below 10,000-20,000) 1.
Clinical Recommendations
- The AABB recommends that platelets should be transfused prophylactically to reduce the risk for spontaneous bleeding in adult patients with therapy-induced hypoproliferative thrombocytopenia, with a platelet count of 10 × 10^9 cells/L or less 1.
- The use of thrombopoietin receptor agonists (such as eltrombopag, avatrombopag, and lusutrombopag) may be considered to increase platelet counts in patients with cirrhosis who are scheduled to undergo a procedure, but their routine use to prevent procedure-related bleeding is not recommended 1.
From the Research
Significance of Platelet Count
The significance of platelet count is highlighted in various studies as a crucial factor in preventing bleeding risks and ensuring safe surgical procedures.
- A low platelet count, also known as thrombocytopenia, can lead to increased bleeding risks, as seen in a patient with primary immune thrombocytopenia (ITP) who experienced epistaxis, melena, hematomas, and ecchymotic patches 2.
- On the other hand, a normal or elevated platelet count can reduce the risk of bleeding and allow for safe surgical interventions, as demonstrated in a study where romiplostim increased platelet counts to allow surgery to proceed safely and on schedule 3.
Role of Romiplostim in Platelet Count Management
Romiplostim, a thrombopoietin receptor agonist, has been shown to be effective in increasing platelet counts in various settings, including:
- Primary immune thrombocytopenia (ITP) 2, 4, 5
- Perioperative thrombocytopenia 3
- Refractory aplastic anemia 4
- Chemotherapy-induced thrombocytopenia 4
- Secondary failure of platelet recovery among allogeneic hematopoietic stem cell transplant patients 6
- Romiplostim works by binding to and activating the TPO receptor on megakaryocyte precursors, promoting cell proliferation and viability, and resulting in increased platelet production 4.
Clinical Implications
The ability to manage platelet counts using romiplostim has significant clinical implications, including: