Thrombocytopenia (Low Platelet Count)

  • Medical Author:
    Siamak N. Nabili, MD, MPH

    Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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How is thrombocytopenia treated?

The treatment of thrombocytopenia is largely dependent upon the cause and the severity of the condition.

Some situations may require specific or emergent treatments, whereas, others need only be managed by occasional blood draws and monitoring of the platelet levels.

In auto-immune thrombocytopenia or ITP, steroids can be used to suppress the immune system in order to impair the destruction of platelets. In more severe cases, intravenous immunoglobulins (IVIG) or monoclonal antibodies may also be given to alter the immune process. In refractory cases, splenectomy (removal of the spleen) may be necessary.

If a drug is thought to be the cause of low platelet count, then it may be discontinued by the supervising physician. In patients with HIT, it is very important to remove and limit the future use of any heparin products, including low molecular weight heparin (like Lovenox), immediately to prevent further immune response against the platelets.

If TTP or HUS is diagnosed, the treatment may include plasma exchange, plasmapheresis, or eculizumab. In cases with severe kidney failure, dialysis may be necessary.

In general, platelet transfusion is not necessary, unless an individual with low platelets (less than 50,000) has an active bleeding or hemorrhage, or needs a surgery or other invasive procedures. Frequently, a platelet transfusion may be recommended without any bleeding if the count is less than 10,000.

In suspected cases of HIT or TTP, transfusion of platelets may not be recommended because the new platelets could potentially make the condition worse and more prolonged.

What are the complications of thrombocytopenia?

The complications of thrombocytopenia may be excessive bleeding after a cut or an injury resulting in hemorrhage and major blood loss. However, spontaneous bleeding (without any injury or laceration) due to thrombocytopenia is uncommon, unless the platelet count is less than 10,000.

Other complications may be related to any other underlying factors or conditions. For example, autoimmune thrombocytopenia related to lupus may be associated with other complications of lupus. TTP or HUS can have many complications including severe anemia, confusion or other neurologic changes, or kidney failure. HIT or heparin induced thrombocytopenia can have devastating complications related to blood clot formation (thrombosis).

Medically Reviewed by a Doctor on 4/30/2015

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