From the Guidelines
Patients with low platelets, or thrombocytopenia, should be carefully monitored for bleeding risks, particularly when counts fall below 50,000/μL, and managed based on the underlying cause, with treatment approaches including medications like corticosteroids, immune globulin, or thrombopoietin receptor agonists, and platelet transfusions for severe cases or active bleeding 1.
Key Considerations
- The main concern with low platelets is an increased bleeding risk, and patients should watch for warning signs including easy bruising, petechiae, prolonged bleeding from cuts, nosebleeds, bleeding gums, blood in urine or stool, and unusually heavy menstrual periods.
- Follow-up typically involves regular blood tests to monitor platelet counts, with frequency depending on severity and underlying cause.
- Treatment approaches vary based on the cause and may include stopping medications that affect platelets, treating underlying infections or autoimmune conditions.
Management of Thrombocytopenia
- For counts below 10,000/μL or with active bleeding, platelet transfusions may be necessary, as suggested by the AABB for patients having elective diagnostic lumbar puncture or major elective nonneuraxial surgery with a platelet count less than 50 × 10^9 cells/L 1.
- However, recent evidence suggests that platelet transfusions do not substantially improve thrombin generation capacity or viscoelastic markers of bleeding risk, and may carry potential risks such as transfusion-related lung injury syndromes 1.
- Thrombopoietin receptor agonists such as eltrombopag or romiplostim may be used to increase platelet counts in patients with cirrhosis, but their use should be individualized and based on the underlying cause of thrombocytopenia.
Procedural Considerations
- Patients with low platelets should inform all healthcare providers about their condition before procedures, and avoid aspirin and NSAIDs which can worsen bleeding risk.
- The decision to perform procedures without prophylactically treating the platelet count should be made on a case-by-case basis, taking into account the potential risks and benefits of the procedure, as well as the patient's individual risk factors for bleeding 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Low Platelets Risks
- 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
Follow-up and Treatment
- 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 2
- Patients with platelet counts of less than 50 × 10^3 per μL should adhere to activity restrictions to avoid trauma-associated bleeding 2
- Romiplostim, a thrombopoietin receptor agonist, has been shown to be effective in increasing platelet counts in patients with immune thrombocytopenia (ITP) 3, 4, 5
Management and Monitoring
- In stable patients being evaluated as outpatients, the first step is to exclude pseudothrombocytopenia by collecting blood in a tube containing heparin or sodium citrate and repeating the platelet count 2
- If thrombocytopenia is confirmed, the next step is to distinguish acute from chronic thrombocytopenia by obtaining or reviewing previous platelet counts 2
- Field medical providers should be aware of the early signs of thrombocytopenia and be able to treat different etiologies in the prehospital environment 6