Summary about Disease
Thrombocytopenia is a condition characterized by a lower-than-normal number of platelets (thrombocytes) in the blood. Platelets are essential for blood clotting. When platelet counts are low, it can lead to excessive bleeding or bruising. The severity of thrombocytopenia can range from mild to severe, depending on the underlying cause and platelet count.
Symptoms
Symptoms of thrombocytopenia can vary depending on the platelet count and the underlying cause. Common symptoms include:
Easy or excessive bruising (purpura)
Superficial bleeding into the skin that appears as pinpoint-sized reddish-purple spots (petechiae), usually on the lower legs
Prolonged bleeding from cuts
Bleeding from the gums or nose
Blood in urine or stools
Unusually heavy menstrual flows
Fatigue
Enlarged spleen
Jaundice
Causes
Thrombocytopenia can be caused by a variety of factors, which are generally categorized into three main mechanisms:
Decreased Platelet Production:
Bone marrow disorders (e.g., leukemia, myelodysplastic syndromes, aplastic anemia)
Viral infections (e.g., HIV, hepatitis C, Epstein-Barr virus)
Medications (e.g., chemotherapy drugs, certain antibiotics, anti-seizure medications)
Excessive alcohol consumption
Nutritional deficiencies (e.g., folate, vitamin B12)
Increased Platelet Destruction:
Immune thrombocytopenic purpura (ITP): an autoimmune disorder where the body attacks its own platelets
Thrombotic thrombocytopenic purpura (TTP): a rare blood clotting disorder
Heparin-induced thrombocytopenia (HIT): a reaction to heparin, an anticoagulant medication
Disseminated intravascular coagulation (DIC): a condition where abnormal blood clotting consumes platelets
Hemolytic uremic syndrome (HUS): a condition that usually occurs after a bacterial infection in the digestive system
Platelet Sequestration:
Splenomegaly (enlarged spleen): The spleen traps and destroys more platelets than normal.
Medicine Used
The medications used to treat thrombocytopenia depend on the underlying cause and severity of the condition. Some common medications include:
Corticosteroids (e.g., prednisone): Suppress the immune system in autoimmune-related thrombocytopenia (ITP).
Intravenous Immunoglobulin (IVIG): Provides a temporary boost in platelet count, often used in ITP.
Anti-D Immunoglobulin (WinRho SDF): Used in Rh-positive individuals with ITP to prevent platelet destruction.
Thrombopoietin Receptor Agonists (e.g., romiplostim, eltrombopag): Stimulate platelet production in the bone marrow.
Rituximab: A monoclonal antibody that targets B cells, used in ITP.
Caplacizumab: Used in the treatment of acquired Thrombotic Thrombocytopenic Purpura (aTTP).
Platelet Transfusions: Used in severe cases of bleeding or when platelet counts are critically low.
Immunosuppressants: Other immunosuppressants may be used in refractory cases of ITP.
Specific Antivirals: Used to treat thrombocytopenia caused by viral infections, for example, in Hep C patients
Is Communicable
Thrombocytopenia itself is generally not communicable. However, if the thrombocytopenia is caused by an infectious agent (e.g., a viral infection like Hepatitis C or HIV), then the underlying infection is communicable, but the low platelet count directly is not.
Precautions
Individuals with thrombocytopenia should take the following precautions:
Avoid activities that could lead to injury or trauma.
Use a soft-bristled toothbrush and avoid vigorous brushing.
Shave with an electric razor rather than a blade.
Avoid taking medications that can interfere with platelet function, such as aspirin and ibuprofen, unless specifically instructed by a doctor.
Inform all healthcare providers about the thrombocytopenia before any medical procedures.
Consider wearing medical alert jewelry or carrying a card indicating the condition.
Avoid constipation, which can lead to straining and bleeding.
Notify your doctor immediately if you experience any signs of bleeding, such as easy bruising, nosebleeds, blood in urine or stool, or heavy menstrual bleeding.
How long does an outbreak last?
The duration of thrombocytopenia depends on the underlying cause.
Acute ITP in children: Often resolves within a few weeks to months.
Chronic ITP: Can persist for months or years, sometimes requiring ongoing management.
Drug-induced thrombocytopenia: Platelet counts usually recover within days to weeks after stopping the offending medication.
Thrombocytopenia due to infections: Duration depends on the course and treatment of the infection.
How is it diagnosed?
Thrombocytopenia is diagnosed through:
Complete Blood Count (CBC): Measures the number of platelets in the blood. A platelet count below 150,000 platelets per microliter (mcL) is considered thrombocytopenia.
Peripheral Blood Smear: A microscopic examination of blood cells to assess their shape and size.
Bone Marrow Aspiration and Biopsy: Evaluates the production of platelets in the bone marrow, especially if the cause of thrombocytopenia is unclear.
Testing for Underlying Causes: This may include tests for autoimmune antibodies (e.g., in ITP), viral infections (e.g., HIV, hepatitis C), and other conditions.
Medication Review: A thorough review of the patient's medication list to identify potential causes of drug-induced thrombocytopenia.
Timeline of Symptoms
The timeline of symptoms can vary greatly depending on the cause and severity of the thrombocytopenia.
Sudden onset: Can occur with acute ITP, drug-induced thrombocytopenia, or certain infections. Symptoms may appear within days.
Gradual onset: Can occur with chronic ITP, bone marrow disorders, or nutritional deficiencies. Symptoms may develop over weeks or months.
Fluctuating: Some conditions, such as chronic ITP, can have periods of remission and exacerbation, causing symptoms to wax and wane.
Important Considerations
Management should be individualized based on the cause and severity of thrombocytopenia.
Pregnant women with thrombocytopenia require special monitoring due to the potential risk of bleeding during delivery and the risk to the fetus.
Children with acute ITP often have a good prognosis and may not require treatment if bleeding is minimal.
Patients with thrombocytopenia should avoid activities that could lead to injury or bleeding.
Close monitoring of platelet counts is essential, especially during treatment or if the condition is unstable.
It is crucial to identify and address the underlying cause of thrombocytopenia.
Always consult with a healthcare professional for diagnosis and treatment of thrombocytopenia.