Thrombocytopenia

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Thrombocytopenia

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Overview

When your blood has too few platelets, mild

to serious bleeding can occur. Bleeding can occur inside your body (internal

bleeding) or underneath your skin or from the surface of your skin (external

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Overview

bleeding).

A normal platelet count in adults ranges

from 150,000 to 450,000 platelets per microliter of blood. A platelet count of

less than 150,000 platelets per microliter is lower than normal. If your blood

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Overview

platelet count falls below normal, you have thrombocytopenia.

However, the risk for serious bleeding

doesn't occur until the count becomes very low—less than 10,000 or 20,000

platelets per microliter. Mild bleeding sometimes occurs when the count is less

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Overview

than 50,000 platelets per microliter.

Many factors can cause a low platelet

count, such as:

-- The body's bone marrow doesn't make enough

platelets.

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Overview

-- The bone marrow makes enough platelets, but

the body destroys them or uses them up.

-- The spleen holds on to too many platelets.

The spleen is an organ that normally stores about one-third of the body's

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Overview

platelets. It also helps your body fight infection and remove unwanted cell

material.

-- A combination of the above factors.

-- How long thrombocytopenia lasts depends on

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Overview

its cause. It can last from days to years.

The treatment for this condition also

depends on its cause and severity. Mild thrombocytopenia often doesn't require

treatment. If the condition causes or puts you at risk for serious bleeding,

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Overview

you may need medicines or blood or

platelet transfusions. Rarely, the spleen may need to be removed.

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Causes

Many factors can cause thrombocytopenia (a

low platelet count). The condition can be inherited or acquired.

"Inherited" means your parents pass the gene for the condition to

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Causes

you. "Acquired" means you aren't born with the condition, but you

develop it. Sometimes the cause of thrombocytopenia isn't known.

In general, a low platelet count occurs

because:

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Causes

-- The body's bone marrow doesn't make enough

platelets.

-- The bone marrow makes enough platelets, but

the body destroys them or uses them up.

-- The spleen holds on to too many platelets.

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Causes

-- A combination of the above factors also may

cause a low platelet count.

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Causes**The Bone Marrow Doesn't Make Enough

Platelets**

Bone marrow is the sponge-like tissue

inside the bones. It contains stem cells that develop into red blood cells,

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Causes**The Bone Marrow Doesn't Make Enough

white blood cells, and platelets. When stem cells are damaged, they don't grow

into healthy blood cells.

Many conditions and factors can damage stem

cells.

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Causes**Cancer**

Cancer, such as leukemia (lu-KE-me-ah) or

lymphoma (lim-FO-ma), can damage the bone marrow and destroy blood stem cells.

Cancer treatments, such as radiation and chemotherapy, also destroy the stem

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Causes**Cancer**

cells.

**Aplastic Anemia**

Aplastic

anemia is a rare, serious blood disorder in which the bone marrow

stops making enough new blood cells. This lowers the number of platelets in

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Causes**Cancer**

your blood.

**Toxic Chemicals**

Exposure to toxic chemicals—such as

pesticides, arsenic, and benzene—can slow the production of platelets.

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Causes**Medicines**

Some medicines, such as diuretics and

chloramphenicol, can slow the production of platelets. Chloramphenicol (an

antibiotic) rarely is used in the United States.

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Causes**Medicines**

Common over-the-counter medicines, such as

aspirin or ibuprofen, also can affect platelets.

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Causes**Alcohol**

Alcohol also slows the production of

platelets. A temporary drop in the platelet count is common among heavy

drinkers, especially if they're eating foods that are low in iron, vitamin B12,

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Causes**Alcohol**

or folate.

**Viruses**

Chickenpox, mumps, rubella, Epstein-Barr

virus, or parvovirus can decrease your platelet count for a while. People who

have AIDS often develop thrombocytopenia.

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Causes**Genetic Conditions**

Some genetic conditions can cause low

numbers of platelets in the blood. Examples include Wiskott-Aldrich and

May-Hegglin syndromes.

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Causes**The Body Destroys Its Own Platelets**

A low platelet count can occur even if the

bone marrow makes enough platelets. The body may destroy its own platelets due

to autoimmune diseases, certain medicines, infections, surgery, pregnancy, and

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some conditions that cause too much blood clotting.

**Autoimmune Diseases**

Autoimmune diseases occur if the body's

immune system mistakenly attacks healthy cells in the body. If an autoimmune

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disease destroys the body's platelets, thrombocytopenia can occur.

One example of this type of autoimmune

disease is immune

thrombocytopenia(ITP). ITP is a bleeding disorder in which the blood

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doesn't clot as it should. An autoimmune response is thought to cause most

cases of ITP.

Normally, your immune system helps your

body fight off infections and diseases. But if you have ITP, your immune system

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attacks and destroys its own platelets. Why this happens isn't known. (ITP also

may occur if the immune system attacks your bone marrow, which makes

platelets.)

Other autoimmune diseases that destroy

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platelets include lupus and rheumatoid arthritis.

**Medicines**

A reaction to medicine can confuse your

body and cause it to destroy its platelets. Examples of medicines that may

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cause this to happen include quinine; antibiotics that contain sulfa; and some

medicines for seizures, such as Dilantin,®vancomycin, and rifampin. (Quinine is

a substance often found in tonic water and nutritional health products.)

Heparin is a medicine commonly used to

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prevent blood clots. But an immune reaction may trigger the medicine to cause

blood clots and thrombocytopenia. This condition is called heparin-induced

thrombocytopenia (HIT). HIT rarely occurs outside of a hospital.

In HIT, the body's immune system attacks a

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substance formed by heparin and a protein on the surface of the platelets. This

attack activates the platelets and they start to form blood clots.

Blood clots can form deep in the legs (deep vein

thrombosis), or they can break loose and travel to the lungs (pulmonary

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embolism).

**Infection**

A low platelet count can occur after blood

poisoning from a widespread bacterial infection. A virus, such as mononucleosis

or cytomegalovirus, also can cause a low platelet count.

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Causes**Surgery**

Platelets can be destroyed when they pass

through man-made heart valves, blood vessel grafts, or machines and tubing used

for blood

transfusions or bypass

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Causes**Surgery**

surgery.

**Pregnancy**

About 5 percent of pregnant women develop

mild thrombocytopenia when they're close to delivery. The exact cause isn't

known for sure.

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Causes**Surgery**

Rare and Serious Conditions That Cause

Blood Clots

Some rare and serious conditions can cause

a low platelet count. Two examples are thrombotic

thrombocytopenic purpura (TTP) and disseminated

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Causes**Surgery**

intravascular coagulation (DIC).

TTP is a rare blood condition. It causes

blood clots to form in the body's small blood vessels, including vessels in the

brains, kidneys, and heart.

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Causes**Surgery**

DIC is a rare complication of pregnancy,

severe infections, or severe trauma. Tiny blood clots form suddenly throughout

the body.

In both conditions, the blood clots use up

many of the blood's platelets.

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Causes**The Spleen Holds On to Too Many Platelets**Usually, one-third of the body's platelets

are held in the spleen. If the spleen is enlarged, it will hold on to too many

platelets. This means that not enough platelets will circulate in the blood.

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Causes**The Spleen Holds On to Too Many Platelets**An enlarged spleen often is due to cancer

or severe liver disease, such as cirrhosis (sir-RO-sis). Cirrhosis is a disease

in which the liver is scarred. This prevents it from working well.

An enlarged spleen also might be due to a

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Causes**The Spleen Holds On to Too Many Platelets**bone marrow condition, such as myelofibrosis (MI-eh-lo-fi-BRO-sis). With this condition,

the bone marrow is scarred and isn't able to make blood cells.

National Heart Lung and Blood Insitute

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Risks

People who are at highest risk for

thrombocytopenia are those affected by one of the conditions or factors

discussed in "What

Causes Thrombocytopenia?" This includes people who:

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Risks

-- Have certain types of cancer, aplastic

anemia, or autoimmune diseases

-- Are exposed to certain toxic chemicals

-- Have a reaction to certain medicines

-- Have certain viruses

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Risks

-- Have certain genetic conditions

People at highest risk also include heavy

alcohol drinkers and pregnant women.

National Heart Lung and Blood Institute

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Symptoms

Mild to serious bleeding causes the main

signs and symptoms of thrombocytopenia. Bleeding can occur inside your body

(internal bleeding) or underneath your skin or from the surface of your skin

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Symptoms

(external bleeding).

Signs and symptoms can appear suddenly or

over time. Mild thrombocytopenia often has no signs or symptoms. Many times,

it's found during a routine blood test.

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Symptoms

Check with your doctor if you have any

signs of bleeding. Severe thrombocytopenia can cause bleeding in almost any

part of the body. Bleeding can lead to a medical emergency and should be

treated right away.

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Symptoms

External bleeding usually is the first sign

of a low platelet count. External bleeding may cause purpura (PURR-purr-ah) or

petechiae (peh-TEE-key-ay). Purpura are purple, brown, and red bruises. This

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Symptoms

bruising may happen easily and often. Petechiae are small red or purple dots on

your skin.

Other signs of external bleeding include:

-- Prolonged bleeding, even from minor cuts

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Symptoms

-- Bleeding or oozing from the mouth or nose,

especially nosebleeds or bleeding from brushing your teeth

-- Abnormal vaginal bleeding (especially heavy

menstrual flow)

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Symptoms

A lot of bleeding after surgery or dental

work also might suggest a bleeding problem.

Heavy bleeding into the intestines or the

brain (internal bleeding) is serious and can be fatal. Signs and symptoms

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Symptoms

include:

-- Blood in the urine or stool or bleeding

from the rectum. Blood in the stool can appear as red blood or as a dark, tarry

color. (Taking iron supplements also can cause dark, tarry stools.)

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Symptoms

-- Headaches and other neurological symptoms.

These problems are very rare, but you should discuss them with your doctor.

http://www.nhlbi.nih.gov/health/health-topics/topics/thcp/signs.html

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Diagnosis

Your doctor will diagnose thrombocytopenia

based on your medical history, a physical exam, and test results. A

hematologist also may be involved in your care. This is a doctor who

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Diagnosis

specializes in diagnosing and treating blood diseases and conditions.

Once thrombocytopenia is diagnosed, your

doctor will begin looking for its cause.

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Diagnosis**Medical History**

Your doctor may ask about factors that can

affect your platelets, such as:

-- The medicines you take, including

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over-the-counter medicines and herbal remedies, and whether you drink beverages

that contain quinine. Quinine is a substance often found in tonic water and

nutritional health products.

-- Your general eating habits, including the

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amount of alcohol you normally drink.

-- Your risk for AIDS, including questions

about blood

transfusions, sexual partners, intravenous (IV) drugs, and exposure to

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infectious blood or bodily fluids at work.

-- Any family history of low platelet counts.

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Diagnosis**Physical Exam**

Your doctor will do a physical exam to look

for signs and symptoms of bleeding, such as bruises or spots on the skin. He or

she will check your abdomen for signs of an enlarged spleen or liver. You also

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will be checked for signs of infection, such as a fever.

**Diagnostic Tests**

Your doctor may recommend one or more of

the following tests to help diagnose a low platelet count. For more information

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about blood tests, go to the Health Topics Blood Tests article.

**Complete Blood Count**

A complete blood count (CBC) measures the

levels of red blood cells, white blood cells, and platelets in your blood. For

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this test, a small amount of blood is drawn from a blood vessel, usually in

your arm.

If you have thrombocytopenia, the results

of this test will show that your platelet count is low.

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Diagnosis**Blood Smear**

A blood smear is used to check the

appearance of your platelets under a microscope. For this test, a small amount

of blood is drawn from a blood vessel, usually in your arm.

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Diagnosis**Bone Marrow Tests**

Bone marrow

tests check whether your bone marrow is healthy. Blood cells,

including platelets, are made in your bone marrow. The two bone marrow tests

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are aspiration (as-pih-RA-shun) and biopsy.

Bone marrow aspiration might be done to

find out why your bone marrow isn't making enough blood cells. For this test,

your doctor removes a sample of fluid bone marrow through a needle. He or she

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examines the sample under a microscope to check for faulty cells.

A bone marrow biopsy often is done right

after an aspiration. For this test, your doctor removes a sample of bone marrow

tissue through a needle. He or she examines the tissue to check the number and

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types of cells in the bone marrow.

**Other Tests**

If a bleeding problem is suspected, you may

need other blood tests as well. For example, your doctor may recommend PT and

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PTT tests to see whether your blood is clotting properly.

Your doctor also may suggest an ultrasound

to check your spleen. An ultrasound uses sound waves to create pictures of your

spleen. This will allow your doctor to see whether your spleen is enlarged.

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National Heart Lung and Blood Institute

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Treatment

Treatment for thrombocytopenia depends on

its cause and severity. The main goal of treatment is to prevent death and

disability caused by bleeding.

If your condition is mild, you may not need

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Treatment

treatment. A fully normal platelet count isn't necessary to prevent bleeding,

even with severe cuts or accidents.

Thrombocytopenia often improves when its

underlying cause is treated. People who inherit the condition usually don't

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Treatment

need treatment.

If a reaction to a medicine is causing a

low platelet count, your doctor may prescribe another medicine. Most people

recover after the initial medicine has been stopped. For heparin-induced

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Treatment

thrombocytopenia (HIT), stopping the heparin isn't enough. Often, you'll need

another medicine to prevent blood clotting.

If your immune system is causing a low

platelet count, your doctor may prescribe medicines to suppress the immune

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Treatment

system.

**Severe Thrombocytopenia**

If your thrombocytopenia is severe, your

doctor may prescribe treatments such as medicines, blood or platelet

transfusions, or splenectomy.

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Treatment**Medicines**

Your doctor may prescribe corticosteroids,

also called steroids for short. Steroids may slow platelet destruction. These

medicines can be given through a vein or by mouth. One example of this type of

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medicine is prednisone.

The steroids used to treat thrombocytopenia

are different from illegal steroids taken by some athletes to enhance

performance.

Your doctor may prescribe immunoglobulins

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or medicines like rituximab to block your immune system. These medicines are

given through a vein. He or she also may prescribe other medicines, such as

eltrombopag or romiplostim, to help your body make more platelets. The former

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comes as a tablet to take by mouth and the latter is given as an injection

under the skin.

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Treatment**Blood or Platelet Transfusions**

Blood or platelet transfusions are used to

treat people who have active bleeding or are at a high risk of bleeding. During

this procedure, a needle is used to insert an intravenous (IV) line into one of

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Treatment**Blood or Platelet Transfusions**

your blood vessels. Through this line, you receive healthy blood or platelets.

For more information about this procedure,

go to the Health Topics Blood

Transfusion article.

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Treatment**Splenectomy**

A splenectomy is surgery to remove the

spleen. This surgery may be used if treatment with medicines doesn't work. This

surgery mostly is used for adults who have immune

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Treatment**Splenectomy**

thrombocytopenia (ITP). However, medicines often are the first course

of treatment.

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Prevention

Whether you can prevent thrombocytopenia

depends on its specific cause. Usually the condition can't be prevented.

However, you can take steps to prevent health problems associated with

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Prevention

thrombocytopenia. For example:

-- Avoid heavy drinking. Alcohol slows the

production of platelets.

-- Try to avoid contact with toxic chemicals.

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Prevention

Chemicals such as pesticides, arsenic, and benzene can slow the production of

platelets.

-- Avoid medicines that you know have

decreased your platelet count in the past.

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Prevention

-- Be aware of medicines that may affect your

platelets and raise your risk of bleeding. Two examples of such medicines are

aspirin and ibuprofen. These medicines may thin your blood too much.

-- Talk with your doctor about getting

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Prevention

vaccinated for viruses that can affect your platelets. You may need vaccines

for mumps, measles, rubella, and chickenpox. You may want to have your child

vaccinated for these viruses as well. Talk with your child's doctor about these

vaccines.

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Thrombocytopenia