What are the other Names for this Condition? (Also known as/Synonyms)

• Decreased Platelet Count
• Low Platelet Count

What is Thrombocytopenia? (Definition/Background Information)

• Thrombocytopenia is a medical term used to describe a condition that results in decreased number of platelets in blood. The platelets are components of blood (or a type of blood cells) that help in clotting. The condition can cause spontaneous bleeding, excessive bleeding in response to a mild injury, red or purple spots on skin, and a propensity to bruising
• Thrombocytopenia can arise from a variety of causes including any disease/condition that affects the bone marrow, certain medications that generate an immune response in the body to destroy platelets, and certain nutritional deficiencies
• Individuals undergoing therapy for cancer, with HIV infection or AIDS, those who use certain medications/drugs, and with some genetic predisposition, may be more susceptible to Thrombocytopenia
• Some potential complications of Thrombocytopenia include significant bleeding in the brain and other vital organs; such incidences can often be fatal. Frequent small bleeding episodes may lead to anemia, kidney abnormalities, and neurological problems
• The treatment options for Thrombocytopenia depend upon the severity of the symptoms and underlying cause. Mild episodes may not require any treatment, and may resolve on their own. Severe cases of bleeding may require transfusion of platelets and suitable medication. The prognosis of Thrombocytopenia depends on the underlying causative factors and severity of the signs and symptoms
• Discontinuation of the causative agent (such as medication) can be an effective preventive measure against recurrent bleeding. Minimizing physical trauma can help individuals with Thrombocytopenia avoid spontaneous bleeding episodes. However, if genetic factors are involved in the cause of the condition, then Thrombocytopenia may not be preventable

Who gets Thrombocytopenia? (Age and Sex Distribution)

Thrombocytopenia can affect any individual irrespective of age, gender, race or ethnic group status.

What are the Risk Factors for Thrombocytopenia? (Predisposing Factors)

The following are the risk factors for Thrombocytopenia:

• Bone marrow cancer
• Exposure to poisonous chemicals
• Genetic predisposition
• Heavy alcohol drinking
• Viral infections, such as those causing mononucleosis and CMV (cytomegalovirus) infection
• Having HIV infection or AIDS
• Radiation therapy and chemotherapy
• Certain drugs and medications; drugs that interfere with platelet formation
• Having surgeries for artificial heart valve and blood vessel grafts
• Thrombotic thrombocytopenic purpura (TTP): It is a rare disorder, where blood clots in the smallest arteries in the body, consume a lot of platelets increasing the risk for thrombocytopenia
• An enlarged spleen may also result in Thrombocytopenia

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Thrombocytopenia? (Etiology)

Thrombocytopenia can be caused by several factors. The following are some known causes for a reduced number of platelets in blood:

• Decreased production of platelets in the bone marrow owing to genetic conditions, medications (drug-induced Thrombocytopenia), radiation therapy, or exposure to toxic chemicals
• Increased rate of destruction of platelets in the bloodstream owing to medications that cause one’s body to destroy platelets (immune Thrombocytopenia)
• Certain medical conditions can cause a reduction in the numbers of platelets by either reduced generation or increased destruction of platelets

The following are some conditions that cause Thrombocytopenia:

• Anemia
• Autoimmune disorders
• Leukemia or cancer in the bone marrow
• Scarring of the liver or cirrhosis
• Bone marrow infections
• Vitamin B12 deficiency
• Folate deficiency: Folic acid deficiency in the diet
• Myelodysplastic syndrome (MDS) causing an improper functioning of the bone marrow
• Exposure to viruses such as chicken-pox, Epstein-Barr, and HIV
• Swelling of the spleen (splenomegaly with hypersplenism)
• Alcoholism
• Aplastic anemia
• Iron deficiency
• Disseminated intravascular coagulation (DIC)
• Sometimes, pregnancy can cause mild Thrombocytopenia

What are the Signs and Symptoms of Thrombocytopenia?

The signs and symptoms of Thrombocytopenia may include: 

• Spontaneous and extensive bleeding (major symptom)
• Red or purple spots in the body, particularly on the lower legs
• Tendency for bruising
• Presence of blood in the urine and stool
• Excessive and unusual bleeding from the nose and mouth (bleeding from the gums)
• Unusually heavy menstrual flow
• Bleeding in the gastrointestinal tract, from the rectum
• Unusual level of bleeding after surgery
• Excess bleeding after dental work
• Bleeding inside the brain, which causes headache and other neurological symptoms (hemorrhagic stroke)

How is Thrombocytopenia Diagnosed?

The diagnosis of Thrombocytopenia may involve:

• A thorough physical examination and an assessment of the signs and symptoms
• A detailed evaluation of the individual’s medical history to get information on
  • Medicines that are currently being taken
  • Whether the beverages the individual takes contain quinine
  • General eating habits
  • Alcohol consumption
  • Risk for HIV infection or AIDS via blood transfusions, multiple sexual partners, and use of intravenous drugs
• Blood tests:
  • To check for the number of different blood cell types (complete blood count)
  • To examine the appearance of platelets under a microscope (peripheral blood smear exam)
  • To check for any recent viral infection
  • Tests such as partial thromboplastin time (PTT) and prothrombin time (PT), to check for blood clotting time
• Bone marrow test to check its health; this may include bone marrow aspiration and/or biopsy
• Abdominal ultrasound imaging to examine for any spleen abnormalities

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Thrombocytopenia?

The following are some complications associated with Thrombocytopenia:

• Severe bleeding in the brain, which may be fatal (brain stroke)
• Unusual bleeding in the digestive tract
• Severe anemia, neurological abnormalities, and kidney failure

How is Thrombocytopenia Treated?

The treatment options for Thrombocytopenia depend on the cause and severity of the condition. The treatment options may include:

• Mild episodes may not require any treatment (based on the healthcare provider's assessment)
• Addressing or treating the condition causing Thrombocytopenia
• Drug-induced Thrombocytopenia can be treated by discontinuing the drug causing the condition, and/or by using alternate medication

Treatment for severe episodes of Thrombocytopenia may include:

• Medications such as:
  • Corticosteroids, to slow down the damage caused to the platelets
  • Immunoglobulins, to improve the immune system
  • Medicines, to increase platelet production
• Platelet transfusions: This may be performed in individuals, who are at a high risk for extensive and continuous bleeding
• Splenectomy: Surgical removal of spleen when medications are not effective, particularly in individuals who have immune Thrombocytopenia

How can Thrombocytopenia be Prevented?

The following preventative measures can be adopted to reduce the incidence of Thrombocytopenia and associated signs and symptoms:

• Stopping excessive drinking
• Minimizing contact with poisonous chemicals such as pesticides, benzene, and arsenic 
• Discontinuing medicines causing decreased platelet count
• Avoiding indiscriminate use of aspirin and other painkillers
• Getting vaccinated against viral infections
• Avoiding injuries and bruises that can start bleeding episodes in such individuals
• Avoiding sports and activities that may cause injuries and bruises
• Taking precautionary vaccination following splenectomy to avoid infections

What is the Prognosis of Thrombocytopenia? (Outcomes/Resolutions)

The prognosis of Thrombocytopenia usually depends on the cause and severity of the condition.

• The prognosis, in case of mild Thrombocytopenia, is excellent
• The prognosis of severe Thrombocytopenia depends on one’s response to treatment and degree of bleeding. Individual’s responding to treatment, generally have good prognosis
• In individuals with severe bleeding episodes (such as bleeding in the brain), the prognosis can be complicated

Additional and Relevant Useful Information for Thrombocytopenia:

The following DoveMed website link is a useful resource for additional information:

http://www.dovemed.com/diseases-conditions/blood-disorders/