From the Guidelines
A low platelet count, or thrombocytopenia, is a condition where you have fewer than 150,000 platelets per microliter of blood, which can impair your body's ability to form blood clots, and according to the most recent evidence, a platelet count below 50,000 increases the risk of bleeding, and counts under 10,000 can lead to spontaneous bleeding that may be life-threatening 1.
Causes and Symptoms
Thrombocytopenia can result from:
- Decreased platelet production in bone marrow (due to medications, infections, or bone marrow disorders)
- Increased platelet destruction (from autoimmune conditions or medications)
- Increased platelet consumption (during severe bleeding or clotting disorders) Common symptoms include:
- Easy bruising
- Prolonged bleeding from cuts
- Spontaneous nosebleeds
- Bleeding gums
- Blood in urine or stool
- Petechiae (small red or purple spots on the skin)
Treatment and Management
Treatment depends on the cause and severity, ranging from:
- Monitoring mild cases
- Medications that boost platelet production
- Corticosteroids to reduce immune system activity
- Blood or platelet transfusions for severe cases
- Addressing underlying conditions causing the low count In patients with therapy-induced hypoproliferative thrombocytopenia, prophylactic platelet transfusion is recommended for a morning platelet count of 10 × 10^9 cells/L or less, and for patients having elective central venous catheter placement or diagnostic lumbar puncture, platelet transfusion is suggested for a platelet count less than 20 × 10^9 cells/L and 50 × 10^9 cells/L, respectively 1.
Recent Guidelines
According to the most recent guidelines, the correction of a low platelet count is not recommended before low-risk procedures, and blood products should be used sparingly to avoid side effects, including fluid overload 1. Additionally, rotational thromboelastometry may be superior to routine coagulation laboratory tests in predicting the risk of bleeding during high-risk procedures.
From the Research
Definition of Thrombocytopenia
- Thrombocytopenia is defined as a platelet count of less than 150 × 10^3 per μL 2, 3.
- It can occur due to decreased platelet production, increased destruction, splenic sequestration, or dilution or clumping of platelets 2.
Clinical Presentation
- Patients with a platelet count greater than 50 × 10^3 per μL are generally asymptomatic 2.
- Patients with platelet counts between 20 and 50 × 10^3 per μL may have mild skin manifestations such as petechiae, purpura, or ecchymosis 2.
- Patients with platelet counts of less than 10 × 10^3 per μL have a high risk of serious bleeding 2.
Causes of Thrombocytopenia
- Common causes of thrombocytopenia include decreased platelet production, increased destruction, splenic sequestration, or dilution or clumping of platelets 2.
- Other causes include infections, malignancy, liver disease, autoimmune disorders, disseminated intravascular coagulation, pregnancy, medications, and coagulation disorders 3.
- Thrombocytopenia can also be caused by heparin-induced thrombocytopenia, thrombotic microangiopathies, and the hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome 2, 4.
Management and Treatment
- Treatment of thrombocytopenia is determined by the underlying cause of the condition 3.
- Transfusion of platelets is recommended when patients have active hemorrhage or when platelet counts are less than 10 × 10^3 per μL, in addition to treatment of underlying causative conditions 2.
- Patients with platelet counts of less than 50 × 10^3 per μL should adhere to activity restrictions to avoid trauma-associated bleeding 2.