From the Guidelines
A low platelet count, or thrombocytopenia, means you have fewer platelets in your blood than normal, which can increase your risk of bleeding, and according to the most recent study 1, a low platelet count per se is not suggested to predict the risk of bleeding in patients with cirrhosis.
Causes and Symptoms
Thrombocytopenia can result from decreased platelet production in bone marrow, increased destruction of platelets in the bloodstream, or platelets being trapped in the spleen. Common causes include certain medications, autoimmune disorders, viral infections, leukemia, chemotherapy, alcohol abuse, or pregnancy complications. Symptoms may include:
- Easy bruising
- Prolonged bleeding from cuts
- Spontaneous nosebleeds
- Bleeding gums
- Blood in urine or stool
- A rash of small red or purple spots called petechiae
Treatment and Management
Treatment depends on the cause and severity, ranging from monitoring mild cases to medications that suppress the immune system, platelet transfusions, or addressing underlying conditions. As stated in the american society of hematology 2019 guidelines for immune thrombocytopenia 1, the decision as to whether a patient can be observed or requires further intervention is highly complex and varies based on comorbidities, medications, and age.
Recommendations
If you have thrombocytopenia, avoid blood thinners like aspirin and ibuprofen, and take precautions to prevent injuries that could lead to bleeding. In patients with severe thrombocytopenia or coagulopathy undergoing high-risk procedures, decisions about prophylactic blood transfusions should include potential benefits and risks, such as transfusion reactions and alloimmunization, as suggested by the aga clinical practice guideline on the management of coagulation disorders in patients with cirrhosis 1.
Quality of Life
Thrombocytopenia can have a significant impact on quality of life, particularly in the first year after diagnosis, related to restrictions on activities, anxiety due to the risk of bleeding, and the burden of treatment and monitoring, as reported in the american society of hematology 2019 guidelines for immune thrombocytopenia 1. Fatigue is common and reported in 22% to 45% of patients with ITP.
From the Research
Low Platelet Count (Thrombocytopenia) Lab Result Meaning
- A low platelet count, also known as thrombocytopenia, is a condition where the blood has a lower than normal number of platelets [<100 x 10(9)/l] 2.
- Thrombocytopenia can be caused by various factors, including immune thrombocytopenia (ITP), a disorder characterized by immune-mediated accelerated platelet destruction and suppressed platelet production 3.
- ITP is diagnosed in patients with a platelet count below 100,000 per cubic millimeter in whom other causes of thrombocytopenia have been ruled out, and its diagnosis is generally one of exclusion 4.
Symptoms and Treatment
- Clinical manifestations of patients with thrombocytopenia may vary from asymptomatic disease to mild mucocutaneous or life-threatening bleeding 4.
- Glucocorticoids are used as first-line treatment for ITP, while other second-line medications, mainly thrombopoietin-receptor agonists (TPO-RA) and rituximab, are given to patients in whom ITP does not remit, or relapses soon after glucocorticoid treatment 4.
- The effect of steroids on activation of platelets has been evaluated, and it was found that platelets in ITP patients exist in an activated state, but treatment with steroids reverses this situation in responsive patients 5.
Diagnosis and Bone Marrow Examination
- The need for a bone marrow examination in the diagnosis of ITP has been assessed, and it was found that routine performance of a bone marrow examination for the diagnosis of ITP is not necessary, provided that a thorough history and physical examination are performed and that the complete blood cell count, peripheral blood smear, and routine clotting studies show no abnormalities apart from thrombocytopenia 6.
- However, in confusing cases of persistent thrombocytopenia, a detailed diagnostic work-up, including evaluation of peripheral-blood smear, bone marrow examination, and cytogenetic testing, is crucial to avoid unnecessary therapy delay 4.
- Bone marrow examinations of young and older patients with ITP have been compared, and it was found that there is no difference between the two groups, and biopsy should not be recommended in typical ITP patients 3.