What is thrombocytopenia?
Thrombocytopenia occurs when there is a low number of platelets in the blood which increases the risk of bleeding. It occurs when the bone marrow makes too few platelets or when too many platelets are destroyed or accumulated within the enlarged spleen. Bleeding in skin and bruising occur.
What are platelets?
Platelets are cells that circulate in the bloodstream and help blood clot.
The blood usually contains about 1 lakh 50 thousand to 5 lakh platelets per microlitre. When the platelet count falls below 50 thousand per microliter of blood bleeding can occur even after relatively minor injury. The most serious risk of bleeding however generally does not occur until the platelet count falls below 20000 platelets per microlitre of blood. At these very low levels, bleeding may occur without any recognized injury.
Causes of thrombocytopenia
Many disorders can cause thrombocytopenia. It can occur in the bone marrow that does not produce enough platelets as happens in leukemia or other bone marrow disorders. Infection with the hepatitis C virus, the HIV that causes AIDS( Acquired Immunodeficiency Syndrome ). Epstein -Barr virus (the usual cause of mononucleosis and many other viruses may result in thrombocytopenia. Platelets can be entrapped in an enlarged spleen as in cirrhosis of liver, myelofibrosis, and Gaucher disease reducing the number of platelets in the bloodstream. Massive red cell transfusion can dilute the concentration of platelets in the blood. Finally, the body may use or destroy platelets, three of the most notable being.
1. Immune Thrombocytopenia
2. Thrombotic thrombocytopenic purpura
3. Hemolytic uremic syndrome.
Some drugs like heparin, certain antibiotics, ethanol, anticancer drugs, and quinine can also cause thrombocytopenia. Drug-induced thrombocytopenia may be a result of :
A.Decreased platelet production by the bone marrow caused by bone marrow toxicity.
B.Increased platelet destruction ( immune-mediated thrombocytopenia )
Symptoms of thrombocytopenia
Your signs and symptoms depend on the platelet count. A lower platelet count will have more severe symptoms You may not have any symptoms. You may bruise or bleed profusely or have tiny red spots on the skin. you may feel tired and exhausted and wish to lie or feel sleepy all the time. There is a lack of desire to work with no energy and a lethargic body all the time. You may have heavy menstrual bleeding with blood in the bowel or stool. these are some of the signs of thrombocytopenia.
Bleeding in the skin may be the first sign of low platelet count. Many tiny red dots petechiae often appear in the skin of lower legs and minor injuries may cause bruises called ecchymoses and purpura.
The gums may bleed and blood may appear in urine and stool. Menstrual periods are usually heavy. Bleeding may be hard to stop. Bleeding worsens as the number of platelet decreases. People who have very few platelets may lose a large amount of blood into the digestive tract or develop life-threatening bleeding in their brains even though they have not been injured. This is known as internal bleeding. The rate at which the symptoms develop can vary depending on the cause and the severity of the thrombocytopenia.
Diagnosis of thrombocytopenia
Doctors suspect thrombocytopenia in people who have abnormal bruising and bleeding. They often check the number of platelets in people who have disorders that might cause thrombocytopenia. Sometimes they discover thrombocytopenia when blood test are done for other reasons in people who have no bruising or bleeding.
Determining the cause of thrombocytopenia is critical to treat the condition. Certain symptoms may help determine the cause. For example, people usually have a fever when thrombocytopenia results from infection. In contrast, they usually do not have a fever when the cause is immune thrombocytopenia or thrombotic purpura or hemolytic uremic syndrome. An enlarged spleen which a doctor may be able to feel during the physical examination suggests that spleen is trapping platelets and thrombocytopenia result from a disorder that is causing the spleen to enlarge.
The platelet count may be measured with an automated counter to determine the severity of the thrombocytopenia and a sample of blood may be examined under the microscope to provide clues to the cause. A sample of bone marrow examined under the microscope (bone marrow biopsy and aspiration ) may be occasionally needed to provide the information about platelet production.
Treatment of thrombocytopenia
1.Avoidance of injury and drugs that affect the platelets
2. Sometimes platelet transfusion
Treating the cause can often treat thrombocytopenia. If it is caused by a drug that is corrected by stopping that particular drug. Thrombocytopenia caused by autoimmune destruction of platelets as in immune thrombocytopenia is treated with prednisone to lessen platelet destruction, drugs to increase the production of platelets in the bone marrow and sometimes removal of the spleen (splenectomy ). People with low blood count and abnormal bleeding should not take medicines or drugs that impair the platelet function such as aspirin or nonsteroidal anti-inflammatory drugs. People who have low platelet count are often treated in the hospital. When bleeding is severe platelets may be transfused, although sometimes the transfused platelets are destroyed by an underlying disorder.
In the case of surgical cases where surgery needs to be performed like removal of the spleen, chitosan may be required as a hemostatic agent. We will learn more about chitosan after knowing what exactly causes thrombocytopenia. It needs to be taken care of.
Many people with thrombocytopenia usually mild disease do not produce any symptoms. The more advanced form can be the number of bleeding disorders.
A blood test to count platelets is the best way to check thrombocytopenia. Most people with HIV have their platelets checked regularly, as the part of their complete blood check usually when viral load and CD4 counts are done. In turn, most people are diagnosed before thrombocytopenia can cause serious problems.
Can thrombocytopenia be prevented?
Thrombocytopenia can happen to anyone although severe is rarely seen in patients with HIV. With the widespread use of HIV treatment, people having HIV taking these treatments are likely at a lower risk of developing thrombocytopenia. Because most people on HIV whether or not to have been tested regularly for the blood test, it is possible to treat thrombocytopenia before it can cause a bleeding disorder.
What increases my rick for thrombocytopenia?
3. Medicines such as heparin or NSAIDs.
4. Cancer treatment such as chemo or radiation.