What is thrombocytopenia?

Platelets are cells normally found in the blood that help the blood to clot. People with thrombocytopenia have fewer platelets than normal.

What worries most is the spontaneous bleeding with counts <10,000 / microL and surgical bleeding with counts <50,000 / microL.

What are the causes?

The possible causes of thrombocytopenia differ depending on the clinical setting in which it occurs:

• Severe thrombocytopenia with bleeding and certain causes of thrombocytopenia (suspected heparin-induced thrombocytopenia, thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, etc.) are medical emergencies that require immediate action.
• In patients with bleeding lacking signs of systemic disease or other abnormalities, the likely diagnoses are drug-induced immune thrombocytopenia or primary immune thrombocytopenia.
• In asymptomatic outpatients With thrombocytopenia, common diagnoses include immune thrombocytopenia (ITP) in which the immune system itself destroys platelets, occult liver disease, HIV infection, and myelodysplastic syndromes.
• Other causes of thrombocytopenia include: infection, sepsis, disseminated intravascular coagulation, drug-induced thrombocytopenia, liver disease, other malignancies, nutrient deficiencies (vitamin B12, folic acid), etc.

What are the symptoms of ITP?

Some people with low platelets sometimes have no symptoms. When people have symptoms, they may have:

• Bleeding easily: This can include nosebleeds or blisters filled with blood inside the mouth. Women with ITP may bleed more than usual during their menstrual periods.
• Bruises: people who are easily injured and bruised easily.

It is very important that the doctor take a good medical history and a good physical examination. The history should focus on previous platelet counts, family history, bleeding, medications, over-the-counter remedies, infectious exposures, dietary practices, and other medical conditions. The physical examination should evaluate signs of bleeding, enlarged nodes, enlarged liver and spleen, thrombosis, and organ involvement.

Is there a test for thrombocytopenia?

Yes and no. There is a test to determine the number of platelets in the blood, called "Platelet count". This is often done as part of a "complete blood count." There is no test that can say for sure if a low platelet count is due to one cause or another.

If it shows that a person has a low platelet count, the doctor will need to investigate the cause to determine if there is another condition that is causing the low platelet count. The main test is called a "complete blood count." Indicates if other blood cell counts are also low or just the platelet count. The pace of subsequent evaluation, additional testing, and is dependent on the clinical presentation, which can range from asymptomatic to acute disease.

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Regarding laboratory tests, in a patient with isolated thrombocytopenia, no additional laboratory tests are required in addition to the Complete blood count and peripheral blood smear. Adults with new thrombocytopenia should be tested for HIV and HCV if they have not been done recently.

In children, immune thrombocytopenia (ITP) is the most common cause of a low platelet count. If the cause of thrombocytopenia is unclear or if a primary blood disorder is suspected, doctors sometimes perform a test called Bone marrow is the cells found within the bones. Produces all blood cells and platelets. A bone marrow biopsy is a procedure that involves using a needle to take a small sample of bone marrow, usually from the hip bones.

If no other cause can be found for a low platelet count, the person is generally said to have ITP.

How is it treated?

Treatment of patients with thrombocytopenia depends on the underlying diagnosis. General principles that apply to all patients include a review of medications that may interfere with normal hemostasis and a decision on whether they should be continued, coordination with anesthesiologists and surgeons before invasive procedures, and correction of abnormalities of the coagulation. Activity restrictions are often not necessary.

• Children with ITP do not need treatment unless they bleed a lot or have a very low platelet count.
• Adults with a very low platelet count or bleeding will probably need treatment. If it is mild, usually no treatment is needed.

Adults with ITP who need treatment are first treated with medicines called steroids, which prevent the body's immune system from destroying platelets. For people who need a very rapid rise in platelet count, a drug called intravenous immunoglobulin can be used, which prevents the body from destroying platelets.

What else might people with ITP need to do?

Depending on the platelet count and symptoms, people may need:

• Avoid certain sports or activities: It is very important that children limit their physical activity and do not play certain sports, especially contact sports.
• Avoid taking certain medications: some, such as aspirin and so-called nonsteroidal anti-inflammatory drugs (or "NSAIDs"), affect platelets.

What if I have ITP and want to get pregnant?

Most women with immune thrombocytopenia have a normal pregnancy and delivery.

There is a possibility that the baby will have a low platelet count after it is born, which will improve in a few days, but it is important to monitor it.

• Thrombocytopenia is a disorder of the platelets in which the platelet count is <150,000. People with thrombocytopenia are at higher risk of bruising or bleeding much more easily.
• If a blood test shows that a person has a low platelet count, the doctor will need to investigate the cause to determine if there is another condition that is causing the low platelet count. The main test is called a "complete blood count."
• Treatment includes a review of medications that can interfere with normal hemostasis and a decision on whether they should be continued, coordination with anesthesiologists and surgeons before invasive procedures, and correction of coagulation abnormalities. Activity restrictions are often not necessary.

Dra. Alexandra Company Barceló

Specialist in Family and Community Medicine

Consultant Physician at Teladoc Health