From the Guidelines
Thrombocytopenia is a medical condition characterized by abnormally low levels of platelets in the blood, typically diagnosed when the count falls below 150,000 platelets per microliter of blood. Platelets, also called thrombocytes, are small cell fragments that help blood clot and prevent excessive bleeding. A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood. This condition can range from mild to severe, with more serious cases (counts below 50,000) posing greater risks for spontaneous bleeding.
Some key points to consider about thrombocytopenia include:
- Thrombocytopenia can result from decreased platelet production in the bone marrow, increased destruction of platelets in the bloodstream, or increased sequestration of platelets in the spleen.
- Common causes include certain medications, autoimmune disorders like immune thrombocytopenic purpura (ITP), viral infections, pregnancy complications, bone marrow disorders, and chemotherapy, as discussed in the context of therapy-induced hypoproliferative thrombocytopenia 1.
- Symptoms may include easy bruising, prolonged bleeding from cuts, spontaneous nosebleeds, bleeding gums, blood in urine or stool, and in severe cases, internal bleeding.
- Treatment depends on the cause and severity, ranging from monitoring mild cases to medications that suppress the immune system, platelet transfusions, or in some cases, surgical removal of the spleen.
In the context of therapy-induced hypoproliferative thrombocytopenia, studies have examined the thresholds for prophylactic platelet transfusions, with findings suggesting that a threshold of 10 × 10^9 cells/L is associated with lower platelet usage and fewer transfusion reactions 1. However, the primary concern in managing thrombocytopenia remains preventing morbidity and mortality related to bleeding, while also considering the quality of life for patients undergoing treatment.
From the FDA Drug Label
Nplate is indicated for the treatment of thrombocytopenia in: Adult patients with immune thrombocytopenia (ITP) who have had an insufficient response to corticosteroids, immunoglobulins, or splenectomy Thrombocytopenia is defined in the context of the treatment as a condition where the degree of thrombocytopenia and clinical condition increases the risk for bleeding.
Thrombocytopenia is a condition characterized by a low platelet count, which can increase the risk for bleeding. 2
From the Research
Definition of Thrombocytopenia
- Thrombocytopenia is defined as a platelet count of less than 150 × 10^3 per μL 3, 4, 5
- It is characterized by an abnormally low number of platelets from multiple causes 4
Causes of Thrombocytopenia
- Thrombocytopenia can occur from decreased platelet production, increased destruction, splenic sequestration, or dilution or clumping 3
- Common causes of thrombocytopenia include:
Symptoms of Thrombocytopenia
- Patients with a platelet count greater than 50 × 10^3 per μL are generally asymptomatic 3
- Patients with platelet counts between 20 and 50 × 10^3 per μL may have mild skin manifestations such as petechiae, purpura, or ecchymosis 3
- Patients with platelet counts of less than 10 × 10^3 per μL have a high risk of serious bleeding 3
Diagnosis and Treatment of Thrombocytopenia
- The first step in evaluating thrombocytopenia is to exclude pseudothrombocytopenia by collecting blood in a tube containing heparin or sodium citrate and repeating the platelet count 3
- Treatment is based on the etiology and, in some cases, treating the secondary cause results in normalization of platelet counts 5
- 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 (when possible) of underlying causative conditions 3