Is Low Platelet Count Serious? Thrombocytopenia

A normal platelet count is between 150,000 to 400,000 platelets per mcL of blood. A platelet count under 150,000 is considered low (thrombocytopenia).

Severe thrombocytopenia refers to a platelet count below 10,000. Internal bleeding can become life-threatening when your platelet count is at this level.

Low platelet counts may be caused by:

• Aplastic anemia (the body stops producing red blood cells)
• Immunological diseases
• Blood clotting abnormalities
• Bleeding disorders
• Hereditary conditions
• Pregnancy
• Bone marrow infection
• Enlarged spleen
• Certain medications, such as quinine, sulfa-containing antibiotics, heparin, and anticonvulsants
• Cancer, such as leukemia
• Cancer treatments including chemotherapy

Low platelet counts or improperly functioning platelets can cause the following symptoms:

• Gum bleeding, nosebleeds, or persistent bleeding following a minor injury
• Blood in your urine, vomit, or stools
• Black, coffee-ground-looking stools
• Easy bruising
• Extreme tiredness
• Heavy menstrual periods
• Petechiae (tiny, flat, red spots under the skin caused by blood leaking from blood vessels)
• Purpura (caused by a minor blood vessel rupture beneath the skin that results in red, purple, or yellow-orange spots on the skin)
• Abnormally enlarged spleen or liver
• Weakness and confusion

• Heparin-induced thrombocytopenia: This can develop after taking the drug heparin (a blood thinner used to treat blood clots). It requires medical treatment because it has the potential to become serious.
• Thrombotic thrombocytopenic purpura: This is a potentially fatal medical emergency related to a low platelet count. Small blood vessels can coagulate, and the blood supply to the kidneys or the central nervous system may be cut off. Depending on the organs involved, symptoms may include bruising or bleeding, fever, neurological issues, chest pain, abdominal pain, and jaundice.
• Thrombocytopenic purpura immune: This is more common in children, although it can also occur in adults after a viral infection, during pregnancy, or after contracting an immune system disease. It results in decreased platelet counts in healthy individuals, although the cause is unknown.

Your doctor may order the following tests to assess you for thrombocytopenia:

• Medical history: You will be asked about your family and medical history, current medications, and symptoms.
• Physical examination: Your doctor will look for bruises, rashes (petechiae), and an enlarged liver or spleen.
• Blood count:  A complete blood count will be taken to assess your platelet, white blood cell, and red blood cell counts
• Blood clot test: This test measures the time it takes for blood to clot. These tests include the prothrombin and partial thromboplastin time.

If your platelet count is low, your doctor may order more tests to determine the cause:

• Bone marrow biopsy: Bone marrow samples may be ordered to detect cancer or bone marrow disorders.
• Imaging tests: An ultrasound or CT scan can detect liver cirrhosis, an enlarged spleen, or enlarged lymph nodes.

Mild cases of thrombocytopenia may not require treatment, and the condition typically does not cause symptoms. The treatment approach depends on the underlying cause and the severity of thrombocytopenia.

Treatments may include:

• Transfusions of platelets or blood: Your doctor may transfuse packed red blood cells or platelets to replace lost blood if your platelet count becomes too low.
• Medications: Your doctor may recommend medications such as corticosteroids to increase your platelet count if your disease is linked to an immune system issue. Stronger drugs can be used to suppress the immune system if preliminary treatment does not work.
• Surgery: Your doctor may suggest surgically removing the spleen (splenectomy) if other therapies are unsuccessful.
• Plasma exchange: This may be necessary for a medical emergency caused by thrombotic thrombocytopenic purpura.

If you are at a higher risk of thrombocytopenia, the following measures may help prevent low platelet counts from occurring:

• Avoid medications that thin the blood and increase the risk of bleeding, including aspirin, Naprosyn, and ibuprofen
• Use caution when engaging in contact sports or other activities that could result in bruising or bleeding
• Reduce your exposure to harmful chemicals
• Use caution when shaving, brushing, and blowing your nose
• Limit alcohol consumption as it can damage the liver and reduce platelet synthesis