Thrombocytopenia: Symptoms, Causes & Treatment

Thrombocytopenia is when the platelet count is below 150,000/µL. Platelets are blood cells that help the blood clot, and low levels can be caused by conditions such as primary immune thrombocytopenia, viral infections, or the use of some medications, such as heparin and valproic acid.

Thrombocytopenia can cause symptoms, especially when the platelet count is 50,000/µL or lower. These symptoms may include bruising, bleeding from the gums or nose, and small red or purple spots on the skin.

If thrombocytopenia is suspected, it is important to see a primary care provider or hematologist for a thorough evaluation. Treatment depends on the underlying cause and may include corticosteroids, chemotherapy, or other therapies when needed.

Thrombocytopenia symptoms

The main symptoms of thrombocytopenia are:

• Bruising and purple patches on the body

• Bleeding gums

• Delayed blood clotting after an injury

• Red or purple spots on the skin

• Nosebleeds

• Blood in the urine

• Heavy periods or periods lasting many days

• Abdominal pain and fever, in some cases

If thrombocytopenia is suspected, it is important to see a primary care provider or hematologist for a thorough evaluation. Treatment depends on the underlying cause and may include corticosteroids, chemotherapy, or other therapies when needed.

What causes low platelets?

Thrombocytopenia may be caused by:

1. Primary immune thrombocytopenia

This is a condition in which platelet production is usually reduced and platelets are destroyed in the blood due to antibodies produced by the body itself.

2. Medication use

Thrombocytopenia can be a side effect of medications such as heparin, acetaminophen, or valproic acid. Some of these medications can stimulate the production of antibodies against platelets, which leads to their destruction, or they can reduce the body's production of new platelets.

3. Infectious diseases

Infectious diseases can also cause thrombocytopenia. Examples include infectious mononucleosis, which is caused by the Epstein-Barr virus, and HIV, which can reduce platelet production in the bone marrow.

4. Liver diseases

Liver diseases, such as cirrhosis and viral hepatitis, are often associated with an enlarged spleen. This can increase platelet destruction in the blood and may also affect the production of thrombopoietin, a hormone that stimulates the production of new platelets.

5. Excessive alcohol consumption

Excessive alcohol consumption may be linked to cirrhosis and folate or vitamin B12 deficiency. These problems can reduce the body's production of platelets or increase their destruction by the spleen, causing thrombocytopenia.

6. Nutrient deficiencies

Nutrient deficiencies, such as folate and vitamin B12 deficiency, can affect the production of blood cells, as seen in megaloblastic anemia. This may lead to lower platelet production and cause thrombocytopenia.

7. Autoimmune diseases

Thrombocytopenia may occur with conditions caused by the production of antibodies by the body itself, such as lupus and Graves' disease. These conditions can also destroy platelets that are circulating in the blood.

8. Pregnancy

Mild thrombocytopenia can occur during pregnancy as a result of the normal changes that happen in the body during this period. When caused by these changes, it usually does not cause bleeding and tends to improve after delivery.

However, thrombocytopenia can also be a sign of other conditions, such as preeclampsia and antiphospholipid syndrome. It should be evaluated by an obstetrician.

9. Cancer

Although rare, some types of cancer, such as leukemia and lymphoma, can reduce platelet production by affecting the bone marrow, resulting in thrombocytopenia.

10. Radiation therapy and chemotherapy

Radiation therapy and chemotherapy, which are usually used to treat different types of cancer, can also affect platelet production in some cases and cause thrombocytopenia.

Confirming a diagnosis

A platelet count can be measured with a complete blood count, or CBC. Platelet levels normally range from 150,000 to 450,000/µL, and thrombocytopenia is diagnosed when the count is below 150,000 platelets per µL of blood.

Treatment options

Treatment for thrombocytopenia is usually guided by a primary care provider or hematologist and depends on the underlying cause.

According to the National Heart, Lung, and Blood Institute, treatment may not be necessary for mild thrombocytopenia, but it may be needed when platelet levels are very low or bleeding is present.

Treatment may include corticosteroids, folic acid or vitamin B12 supplementation, stopping a medication that is contributing to the low platelet count, or chemotherapy in some cases.

In mild cases, typically with a platelet count between 100,000 and 150,000/µL and no other symptoms or concerning findings, routine monitoring with blood tests may be all that is needed.