Platelets are important components of the body and control bleeding, making them crucial for the survival of patients who have undergone surgeries, including organ transplants. They also help the body recover from traumatic injuries as well as fight cancer and other chronic diseases.
When a patient has a low platelet count, it can impact the safety of several bedside procedures. If thrombocytopenia occurs, it must thus be addressed prior to certain clinical procedures.
Let’s explore all there is to the condition, including thrombocytopenia treatment and prognosis.
What Is Thrombocytopenia?
Thrombocytopenia refers to a condition where there is a low ratio of platelets in the blood. This can hinder the body’s ability to form clots as the platelets are unable to clump together, causing excessive or prolonged bleeding and easy bruising.
It can also be fatal in case of severe injuries such as brain bleeding or compound fractures.
The lower limit of a normal platelet count among adults is 150,000 per microliter. In cases where thrombocytopenia occurs, the number of platelets is even lower.
- Mild thrombocytopenia: the platelet levels are between 140,000 and 101,000 per microliter
- Moderate thrombocytopenia: platelet levels are within the range of 100,000 and 51,000 per microliter
- Severe thrombocytopenia: platelet levels are between 51,000 and 21,000 per microliter
Spontaneous bleeding can take place if the platelet count is 10,000 per microliter. If the count is below 50,000 per microliter, it can lead to surgical bleeding.
Causes of Thrombocytopenia
Thrombocytopenia treatment depends on what has caused the condition. It is thus crucial to know why a patient has thrombocytopenia. Knowing the root cause will ensure the effectiveness of the thrombocytopenia therapeutic procedures. Here are the most common causes of thrombocytopenia:
Bone Marrow Issues
Bone marrow is the tissue inside the bone that is responsible for producing components of blood, including platelets. Sometimes, the bone marrow may be unable to create enough platelets due to underlying issues such as:
- Exposure to radiation or toxic chemicals
- Chemotherapy
- Excess alcohol consumption
- Cirrhosis
- Viral infections such as rubella, mumps, chickenpox, and HIV
- Leukemia, lymphoma, and other types of cancers
- Genetic conditions including May-Hegglin and Wiskott-Aldrich syndromes
- Aplastic anemia
- Myelodysplasia
- Vitamin B12, iron, folate, and other deficiencies
Addressing these concerns might enable the bone marrow to produce more platelets.
Platelet Destruction
Among individuals who do not have thrombocytopenia, platelets typically live for around 7 to 10 days. The body may destroy the platelets more rapidly than normal due to:
- Medications such as antibiotics, diuretics, anticoagulants, and anti-seizure medications
- Pregnancy, particularly in the later stages of the third trimester
- A bacterial infection
- Surgery such as blood transfusions or bypasses
- Enlarged spleen
- Hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, disseminated intravascular coagulation, and other rare conditions
If an abnormal amount of platelets is rapidly destroyed, the patient may require thrombocytopenic treatment.
Symptoms of Thrombocytopenia
Mild thrombocytopenia often doesn’t cause any serious symptoms and can be difficult to pinpoint. Meanwhile, more severe thrombocytopenia can manifest in different ways such as:
- Bleeding gums or swollen gums
- Bloody stool
- Petechiae, or small red or purple dots that look like a rash on the lower leg
- Menstrual bleeding that lasts longer than usual or is heavier than usual
- Bruises
- Rectal bleeding
- Red, brown, or purple spots on the skin caused by leaking blood vessels
- Bloody urine
- Bloody vomit
Patients who display these symptoms may require bedside procedures and thrombocytopenia treatment.
How Is Thrombocytopenia Diagnosed?
Thrombocytopenia can be diagnosed with tests such as:
- Peripheral blood smear whereby the platelets are examined under a microscope
- Complete blood count (CBC) test to determine the prevalence of platelets and the red and white blood cell levels
- Ultrasound to check for an enlarged spleen
- Bone marrow biopsy: typically performed if blood tests reveal a low platelet count
- Blood clot test to measure how much time the blood takes to clot, which may include a partial thromboplastin time test (PTT) or prothrombin time test (PT)
Additionally, if thrombocytopenia is suspected, the clinician can perform a physical examination to check for rashes, bruises, and other symptoms. Healthcare workers must also look into the patient’s complete medical history, including prescription and over-the-counter medications that the patient is taking.
Bedside Procedures and Thrombocytopenia Treatment
Thrombocytopenia treatment primarily involves addressing the underlying cause of the low platelet count. Other treatment options include:
Corticosteroids
Administering steroids can prevent excessive bleeding due to thrombocytopenia. They can reduce antibody production against platelets which can allow the platelet levels to increase over the course of two to four weeks.
Steroids are thus an effective bedside treatment option for immune thrombocytopenia.
Splenectomy
Immune thrombocytopenia may happen when the spleen blocks too many platelets. A splenectomy is thus a viable bedside treatment option that entails the surgical removal of the spleen.
The first time a splenectomy was conducted to treat thrombocytopenia was in 1916. It remains an effective treatment even today.
Blood or Platelet Transfusion
A platelet transfusion may be necessary to prevent excessive bleeding and manage thrombocytopenia, particularly before major surgeries and procedures such as:
- Central line placement
- Epidural anesthesia
- Endoscopic procedures
- Lumbar puncture
- Ocular surgery or neurosurgery
The effects of a transfusion are usually temporary, and the platelet count typically only rises for around three to four days. However, this is enough for a patient to safely undergo different procedures as it can reduce the risk of excessive blood loss.
Final Thoughts
Thrombocytopenia is a serious condition that can cause serious complications such as internal bleeding. It can also be fatal in some cases.
As a healthcare provider, knowledge about thrombocytopenia is crucial as it can impact the outcomes of medical surgeries.
If you want to learn more about thrombocytopenia and other medical conditions, consider enrolling in our courses at Hospital Procedures Consultants. They’re designed to give emergency and hospital healthcare providers comprehensive, quality, and evidence-based education.
Resources:
Jinna, Sruthi, Khandar, P. Thrombocytopenia. CME. 07/2023
Patel, I. Rahim, S. Davidson, J. Hanks, S. Tam, A. Walker, G. Sarode, R. Weinberg, I. Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions-Part II: Recommendations: Endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe J Vasc Interv Radiol. 2019 Aug;30(8):1168-1184.e1. doi: 10.1016
Slichter, S. Relationship between platelet count and bleeding risk in thrombocytopenic patients. Transfus Med Rev. 2004 Jul;18(3):153-67. doi: 10.1016
Remiker, A. Neunert, C. Splenectomy for immune thrombocytopenia: the evolution and preservation of treatment Haematologica. 2020 Nov 1; 105(11): 2507–2509. Published online 2020 Nov 1. doi: 10.3324/haematol.2020.261099
Khan, A. Anwer, F. Platelet Transfusion. CME. 04/2023
Squires, J. Indications for platelet transfusion in patients with thrombocytopenia. Blood Transfus. 2015 Apr; 13(2): 221–226