From the Guidelines
Low platelets, or thrombocytopenia, requires a thorough evaluation by a healthcare provider to determine the underlying cause and severity, and treatment should be guided by the most recent and highest quality evidence, such as the 2021 study by the American Association for the Study of Liver Diseases 1.
Causes and Severity
Thrombocytopenia can result from decreased production, increased destruction, or increased consumption of platelets. The severity of thrombocytopenia can vary widely, and treatment depends on the underlying cause and the patient's clinical condition.
- Mild cases (>50,000 platelets) often require no specific treatment beyond monitoring.
- Moderate to severe cases may require treatments such as corticosteroids, intravenous immunoglobulin (IVIG), or immunosuppressants.
Treatment
Platelet transfusions should be reserved for severe thrombocytopenia (<10,000 platelets) or active bleeding, as recommended by the American Society of Clinical Oncology 1.
- For patients with thrombocytopenia resulting from impaired bone marrow function, prophylactic platelet transfusion should be administered to reduce the risk of hemorrhage when the platelet count falls below a predefined threshold level.
- The use of TPO receptor agonists, such as avatrombopag and lusutrombopag, may be considered for patients with chronic liver disease who are scheduled to undergo a procedure, as they have been shown to increase platelet counts without increasing the risk of thrombotic complications 1.
Management
While awaiting treatment, patients with low platelets should:
- Avoid activities with bleeding risk
- Not take aspirin or NSAIDs
- Watch for warning signs like unusual bruising, petechiae, nosebleeds, or blood in urine or stool The management of thrombocytopenia should be individualized, taking into account the patient's underlying condition, clinical status, and potential risks and benefits of treatment, as recommended by the international consensus report on the investigation and management of primary immune thrombocytopenia 1.
From the Research
Definition and Causes of Low Platelets
- Low platelets, also known as thrombocytopenia, is defined as a platelet count of less than 150 × 10(3) per µL 2.
- The etiology of thrombocytopenia is often not obvious and may require additional investigation to determine the cause.
- Causes of thrombocytopenia can include immune thrombocytopenia (ITP), drug-induced thrombocytopenia, pseudothrombocytopenia, and gestational thrombocytopenia during pregnancy 2.
Symptoms and Treatment of Low Platelets
- Symptoms of thrombocytopenia can range from mild to severe and may include purpura, bleeding with minimal trauma, and spontaneous bleeding 2.
- Treatment of thrombocytopenia is based on the underlying cause and may include corticosteroids, intravenous immunoglobulins (IVIG), rituximab, thrombopoietin receptor agonists, and splenectomy 3, 4.
- In some cases, treatment of the underlying cause can result in normalization of platelet counts 2.
Diagnosis and Management of Immune Thrombocytopenia
- Primary immune thrombocytopenia (ITP) is an autoimmune disorder characterized by a low platelet count (<100 × 10(9)/L) with an increased risk of bleeding 4.
- Diagnosis and management of ITP are guided by recent guidelines from the International Consensus Report (ICR) expert panel and the American Society of Hematology (ASH) 4.
- Treatment approaches for ITP are more rational and evidence-based than in the past, and patients should be treated based on their individual needs rather than disease stage 4.