From the Guidelines
A low platelet count of 103 (thousand per microliter) requires medical evaluation to determine the underlying cause, and according to the most recent guidelines, prophylactic platelet transfusion should be considered to reduce the risk of hemorrhage when the platelet count falls below a predefined threshold level, as recommended by the American Society of Clinical Oncology 1. To work up a low platelet count, the following steps should be taken:
- Consult with a healthcare provider who will likely order additional blood tests, including:
- Complete blood count with peripheral smear
- Liver function tests
- Tests for autoimmune conditions
- Check for medication side effects, as drugs like heparin, antibiotics, and some seizure medications can lower platelet counts
- Bone marrow examination might be necessary if other tests are inconclusive Treatment depends on the cause, and for most patients with counts above 50,000, no specific treatment is needed beyond monitoring, as this level is usually sufficient to prevent spontaneous bleeding, as supported by studies 1. The body normally maintains platelet counts between 150,000-450,000 per microliter, and counts below this range can result from decreased production in bone marrow, increased destruction in circulation, or splenic sequestration. It is essential to note that the decision to administer platelet transfusion is not based solely on the platelet count but should be individualized for specific clinical settings, as discussed in the guidelines 1.
From the Research
Evaluation of Thrombocytopenia
To work up a low platelet count of 103, the following steps can be taken:
- Exclude pseudothrombocytopenia by collecting blood in a tube containing heparin or sodium citrate and repeating the platelet count 2
- Distinguish acute from chronic thrombocytopenia by obtaining or reviewing previous platelet counts 2
- Identify the underlying cause of thrombocytopenia, which can include decreased platelet production, increased destruction, splenic sequestration, or dilution or clumping 2
Common Causes of Thrombocytopenia
Some common causes of thrombocytopenia include:
- Immune thrombocytopenia (ITP) 3, 4, 5
- Drug-induced thrombocytopenia 2
- Hepatic disease 2
- Heparin-induced thrombocytopenia 2
- Thrombotic microangiopathies 2, 6
Management of Thrombocytopenia
The management of thrombocytopenia depends on the underlying cause and the severity of the condition:
- Transfusion of platelets may be recommended for patients with active hemorrhage or platelet counts less than 10 × 10^3 per μL 2
- Corticosteroids are a common first-line therapy for ITP 3, 4, 5
- Patients with platelet counts less than 50 × 10^3 per μL should adhere to activity restrictions to avoid trauma-associated bleeding 2