Thrombocytopenia consists in a decrease in the number of platelets in the blood, a condition that impairs coagulation, and may cause symptoms such as purple or red spots on the skin, bleeding gums or nose, and red urine, for example.
Platelets are essential components of blood for clotting, facilitating wound healing and preventing bleeding. However, there are several situations that can cause a decrease in the amount of platelets, such as infections, for example dengue, use of medications such as heparin, immunity-related diseases such as thrombocytopenic purpura and even cancer.
The treatment for low platelets should be done according to their cause by a general practitioner or hematologist, and it may only be necessary to control the cause, use medication or, in very serious cases, the transfusion of platelets.
Platelets are considered to be low when the blood count is less than 150,000 cells/mm³ of blood, and, most of the time, this does not cause symptoms. However, a person may have a greater tendency to bleed, and other symptoms may appear, such as:
- Purple or red spots on the skin, such as bruising;
- Bleeding gums;
- Bleeding from the nose;
- Urine with blood;
- Stool bleeding;
- Bulky menstruation;
- Bleeding wounds that are more difficult to control.
These symptoms may occur in anyone with low platelets, but are more common when the platelet count is very low, such as below 50,000 cells mm³ of blood, or when they are associated with another disease, such as dengue or cirrhosis, which worsen the bloods capacity to coagulate.
One of the diseases most commonly associated with platelet reduction is Idiopathic thrombocytopenic purpura, also called immune thrombocytopenic purpura.
Possible causes for a low platelet count
Platelets are produced in the bone marrow, and live for about 10 days, because they are constantly being renewed. Factors that interfere with the number of blood platelets are:
1. Destruction of platelets
Some situations can cause platelets to live for less time in the bloodstream, which may cause their number to decrease. Some of the main causes are:
- Infections by viruses, such as dengue, Zika, mononucleosis and HIV, for example, or by bacteria, which affect the survival of platelets due to changes in your immunity;
- Use of some medications, such as Heparin, Sulfa, anti-inflammatory drugs, anti-convulsants and antihypertensives, for example, as they can cause reactions that destroy platelets;
- Autoimmune diseases, which can develop reactions that attack and eliminate platelets, such as lupus, immune thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic purpura (TTP), hemolytic-uremic syndrome, and hypothyroidism, for example.
Immune diseases tend to cause a more severe and persistent platelet reduction than the use of medications and infections. In addition, each person may have a different reaction, which varies according to the body's immunity and response, so it is common to see people with lower platelets in some cases of dengue than in others, for example.
2. Lack of folic acid or Vitamin B12
Substances like folic acid and vitamin B12 are essential for hematopoiesis, which is the process of forming blood cells. However, a lack of folic acid or vitamin B12 may lead to decreased production of red blood cells, white blood cells and platelets. These deficiencies are common in vegans without nutritional monitoring, malnourished people, alcoholics, and people with diseases that cause hidden bleeding, such as gastric or intestinal bleeding.
Here are some tips on what to eat to avoid folic acid and vitamin B12 deficiency.
3. Changes to bone marrow
Some changes in the functioning of the bone marrow cause a reduction in the production of platelets, which can happen to several reasons, such as:
- Bone marrow diseases such as aplastic anemia or myelodysplasia, for example, which cause a decrease in the production or wrong production of blood cells;
- Bone marrow infections, such as by HIV, Epstein-Barr virus and varicella;
- Cancer that affects the bone marrow, such as leukemia, lymphoma, or metastases, for example;
- Chemotherapy, radiation therapy or exposure to substances toxic to the bone marrow, such as lead and aluminum;
In these cases, there is also anemia and a decrease in white blood cells, that can be observed in a blood test because the bone marrow is responsible for the production of various blood components.
4. Problems in spleen function
The spleen is responsible for eliminating several blood cells that get old, including platelets, and if for some reason it is enlarged, like when you have a disease such as cirrhosis, sarcoidosis and amyloidosis, there may be elimination above normal of platelets that are still healthy.
5. Other causes
In the presence of low platelets without a definite cause, it is important to think of other reasons for the results, such as the laboratory used, because platelet aggregation may occur in a blood collection tube, due to the presence of a reagent in the tube. So, it is important that the exam be repeated in these cases.
Alcoholism can also cause platelet reduction, because alcohol is toxic to blood cells, and also affects the bone marrows production.
In pregnancy, physiological thrombocytopenia may occur due to dilution of the blood by fluid retention, which is usually mild, and resolves spontaneously after delivery.
What to do if your platelet count is low
If thrombocytopenia is detected during testing, it is important to take some precautions to avoid the risk of bleeding, such as avoiding intense exertion or contact sports, avoiding alcohol consumption and not using medications that can affect platelet function or increase the risk of bleeding, such as aspirin, anti-inflammatory drugs, anti-coagulants and ginkgo-biloba, for example.
The cautions you take should be reinforced when platelets are below 50,000 cells /mm³ in the blood, and it is worrisome when the count is below 20,000 cells/mm³ in the blood, and even hospitalization may be necessary for observation in some cases.
Your diet should be well balanced, rich in cereals, fruits, vegetables, and lean meats, to aid in blood formation and body recovery.
Platelet transfusion is not always necessary, because with care and treatment, you can recover or live well. However, the doctor can give you other guidelines when there are bleeding situations, when surgery is necessary, when platelets are below 10,000 cells / mm³ in the blood or when they are below 20,000 cells / mm³ in the blood, but also when you have a fever or need to do chemotherapy, for example.
How is treatment done
After determining the reason why your platelets are low, your doctor will indicate the best treatment options, which can be:
- Withdrawal of the cause, such as medications, treatment of diseases and infections, or reduction of alcohol consumption, which trigger low platelets;
- Use of corticosteroids, steroids or immunosuppressants, when it is necessary to treat an autoimmune disease;
- Surgical removal of the spleen, which is splenectomy, when thrombocytopenia is severe and caused by increased spleen function;
- Blood filtration, called plasma exchange or plasmapheresis, is a kind of filtration of a part of the blood that contains antibodies and components that are impairing the functioning of your immune system and blood circulation, indicated in diseases such as thrombotic thrombocytopenic, hemolytic-uremic syndrome for example.
In case of cancer, treatment is done for the type and severity of this disease, with chemotherapy or bone marrow transplantation for example.