What Is Thrombocytopenia (Low Blood Platelets)?

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Thrombocytopenia is the medical term for low blood platelets. Platelets are a type of cell in your bloodstream that help form blood clots. When you get a cut or injury to a blood vessel, blood clots form to plug the hole and stop the bleeding. If you have low platelets, you may not be able to form clots properly. That can put you at risk for severe bleeding. 

Normal platelet counts for adults are between 150,000 and 450,000 platelets per microliter (uL) of blood. Thrombocytopenia is a platelet count below 150,000. This condition can be more or less severe. The fewer platelets you have, the more serious your symptoms may be. Most people have a steady platelet count over time, so large changes in your platelet count can also be cause for concern.

If you’ve been diagnosed with thrombocytopenia or you have a low platelet count on your blood tests, work with your doctor to make a treatment plan. The good news is that there are effective treatments that can help manage symptoms and prevent complications.

What Are the Symptoms of Thrombocytopenia?

Platelets are an important part of the blood clotting process in your body. When platelet counts are too low, you have an increased risk of bleeding. Symptoms of thrombocytopenia include:

  • Bleeding from your gums after brushing your teeth
  • Nosebleeds that are hard to stop
  • Easy bleeding or bruising
  • Blood in your stool (poop)
  • Small red spots on your skin (called petechiae)

If you have bleeding that won’t stop, get emergency medical help right away.

The risk for severe bleeding depends on how low your platelet count is. If you have mild thrombocytopenia, your risk for life-threatening bleeding is not high. However, if you have a moderately low platelet count (less than 75,000/uL), you may be at risk of serious bleeding from traumatic injuries such as car accidents. At this level, it may also be dangerous to have surgery. 

If your platelet count is severely low (less than 30,000/uL), you may be at risk for severe spontaneous bleeding (bleeding that happens for no apparent reason). Trauma, surgery or other blood disorders can also raise your risk for severe bleeding. Work with your doctor to understand what your platelet count means for you.

What Causes Thrombocytopenia?

The lifespan of platelets is seven to 10 days, so your body is constantly making, using and destroying platelets. Thrombocytopenia can happen due to three different problems in this process — if your body doesn’t make enough new platelets, destroys more platelets than normal, or traps too many platelets in your spleen instead of releasing them into your blood. 

Decreased Platelet Production

One type of thrombocytopenia happens when your body doesn’t make enough new platelets. Your body makes platelets in your bone marrow. So common causes of decreased platelet production include bone marrow cancer and problems with your bone marrow from chemotherapy. Other causes include:

  • Infections, such as hepatitis C, HIV, mumps and rubella
  • Chronic heavy drinking
  • Vitamin B12 deficiency
  • Folate deficiency

Increased Platelet Destruction

Another type of thrombocytopenia happens when your body destroys too many platelets. This type is sometimes caused by problems with the immune system, like autoimmune disorders or immune reactions to blood transfusions. One specific type is called immune thrombocytopenia (ITP). This happens when your immune system attacks your platelets. 

Other causes include: 

  • Infections
  • Side effects of certain medicines, like certain blood thinners and antibiotics
  • Side effects of a mechanical heart valve
  • Sepsis (a severe complication from an infection)
  • Preeclampsia (a pregnancy complication)

Increased Platelet Sequestration

The third type of thrombocytopenia happens when your body sequesters (traps) too many platelets inside the spleen. It’s normal for your body to capture and hold some platelets in the spleen. But if there’s increased platelet sequestration, that means too many platelets are trapped in the spleen instead of floating around in the bloodstream. 

Causes of this type include:

  • Chronic heavy drinking
  • Liver disease
  • Enlarged spleen
  • Pregnancy

It can also be caused by excessive bleeding, blood clots or high blood pressure in the lung or too much intravenous fluid.

Am I at Risk for Thrombocytopenia?

You may be at higher risk for thrombocytopenia if you:

  • Have a family history of thrombocytopenia
  • Have had cancer, liver disease or an autoimmune disease
  • Take certain medicines, like heparin or certain antibiotics
  • Are pregnant, especially if you have preeclampsia during pregnancy
  • Drink heavily over a long period of time

Other risk factors include recent heart valve replacement, recent blood transfusion and certain infections. If you have a low platelet count or unexplained bleeding, your doctor will ask to about these risk factors to help diagnose thrombocytopenia.

How Do Doctors Diagnose Thrombocytopenia?

To find out if you have thrombocytopenia, your doctor will do a blood test called a complete blood count. This test checks the levels of all the different types of cells in your blood, including platelets. If your platelet count is below 150,000/uL, you have thrombocytopenia. But your doctor may do additional tests or ask you some questions to find out what type of thrombocytopenia you have and what’s causing it.

If you get an annual physical, your doctor may diagnose thrombocytopenia based on routine blood work. In this case, your doctor will do a complete medical history and physical exam to check for underlying health conditions that can lead to thrombocytopenia. You may also have blood tests as part of your medical care when you’re sick or injured — and doctors may find out you have thrombocytopenia that way.

What Are the Treatments for Thrombocytopenia?

Your treatment will depend on the cause of your thrombocytopenia. For example:

  • If your body isn’t making enough new platelets, you may need blood or platelet transfusions. 
  • If your thrombocytopenia is a side effect of a medicine or transfusion, you may need to stop taking that medicine or transfusion.
  • If you have an autoimmune disorder or an infection, your doctor may prescribe medicine to treat that condition.
  • If you have cancer, you may need chemotherapy or radiation treatments.
  • If your body is trapping too many platelets in the spleen, you may need surgery to remove your spleen. 
  • If heavy drinking or another behavior is causing your thrombocytopenia, your doctor can help you make a plan to stop drinking or make other lifestyle changes. 

Overall, there are as many treatment options as there are causes of thrombocytopenia. So it’s important to work with your doctor to figure out the cause and make a treatment plan that’s right for you.

Your Next Steps to Stay Healthy If You Have Thrombocytopenia

If you have thrombocytopenia, you can take steps at home to stay healthy. The most important step is to keep up with your doctor appointments and blood work. Ask your doctor how often you need blood tests and make sure to go to all your follow-up appointments.

If you have thrombocytopenia from an enlarged spleen, your doctor may recommend lifestyle changes to avoid injuries. This is because injuries can cause an enlarged spleen to rupture. You may need to switch from contact sports to non-contact sports. 

If you drink heavily or you have liver disease, you’ll need to stop drinking. Alcohol use disorder is a common problem, and there are resources available to help you. Talk with your doctor about ways to cut back on drinking. 

Depending on the cause of your thrombocytopenia, there may be other steps you can take, like avoiding certain over-the-counter medicines. Remember, the most important step is to work with your doctor to find the cause and get the treatment you need.

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