Introduction

Blood cells known as platelets help stop bleeding by the formation of blood clots. In adults, an ordinary platelet count or level is between 150,000 and 450,000 platelets per microliter of blood. Insufficient platelet production by the bone marrow results in low platelet count (thrombocytopenia). People who have this medical condition may bleed easily and find it difficult to stop the bleeding. Those with specific medical disorders, such as autoimmune illness, or who consume certain prescription medications may have thrombocytopenia.¹

Signs and Symptoms of Low Platelet Count

One of the initial signs, when they do occur, is a cut or nosebleed that will not stop bleeding¹. Additional signs include:

• Gum bleeding may show as blood on your toothbrush and swollen-looking gums.
• Blood in stool: If you have blood, your stool might be very dark. 
• Blood in the pee (urine): You may have blood in your urine if the toilet water is a pale pink colour after you urinate.
• Hematemesis, or having blood in your vomit, is a symptom of upper gastrointestinal haemorrhage.

Symptoms of low platelet count: 

• Heavy menstrual periods: Menorrhagia may be present if your periods run longer than seven days or if you are bleeding more heavily than normal.
• Petechiae: In this condition, the skin of your lower thighs has tiny little, red, or purple dots.
• Purpura: It involves purple, crimson, or brown large spots on your skin. This happens when small blood vessels underneath your pores and skin leak blood.
• Bruises: Bruises appear while blood pools underneath your skin. You may develop bruises more easily than ordinary.
• Rectal bleeding: You might also be aware of blood in the toilet water or once you wipe.¹

Some patients of moderately low platelet count do not exhibit any symptoms. They may also report nonspecific symptoms like:

• Bleeding from the gums and other areas of the mouth
• Bruising
• Nosebleeds
• Rash  on your skin.²

When to See a Doctor

Thrombocytopenia symptoms can develop in no time or over the years. It might also cause bleeding in more than one site of your body. Seek immediate medical help if:

• When you can notice any signs of low platelet count, such as unexpected bleeding or spots that cannot be categorized otherwise. 
• You have a fever or other symptoms of infection. If you had a splenectomy, you are at increased risk of infection.¹

Causes of Low Platelet Count

There are three primary causes of reduced platelets:

1. Insufficient platelets are produced in the bone marrow: If you suffer from either of the following kinds of disorders, your bone marrow might not produce enough platelets.

• In aplastic anaemia, the bone marrow fails to produce enough blood cells.
• Bone marrow cancer
• Liver scarring caused by cirrhosis
• Folate/Vitamin B9 deficiency
• In the case of myelodysplastic syndrome, the bone marrow either produces insufficient or faulty blood cells.
• Vitamin B12 insufficiency²
• Chemotherapy: Many cancer medications damage bone marrow.  

2. Increased platelet deterioration in the blood²

• Specific sorts of cancers: Certain cancers which include leukaemia or lymphoma can lower your platelet matter. The unusual cells in such cancers can outnumber healthy cells inside the bone marrow, where platelets are made.³

3. Increased platelet deterioration in the liver or spleen² 

• It may be due to a disorder in which the proteins responsible for blood clotting become overly active, usually occurring during a severe illness.
• Can be due to an enlarged spleen
• May also be due to a condition in which the immune system mistakenly destroys platelets (referred to as ITP- immune thrombocytopenia).

4. Infections

• Viral infections such as HIV, hepatitis C, Epstein-Barr virus, parvovirus, mumps, varicella (chickenpox), rubella (German measles), and Zika virus can lead to low platelet count.
• Sepsis, a severe infection in the body, can cause suppression of bone marrow function.
• The bacteria Helicobacter pylori and tick-borne infections like leptospirosis, brucellosis, and anaplasmosis are associated with low platelet count.
• Infections caused by malaria and parasites can result in both low platelet count and haemolytic anaemia (breakdown of red blood cells).⁵

Risk Factors for Low Platelet Count

The factors that contribute to a low platelet count are crucial for identifying individuals who may be at risk.

• Age: Low platelet count is more common after the age of 50. However, genetically inherited forms of this condition usually affect babies and children.
• Ancestry and genetics can cause reduced platelet count⁴
• Autoimmune conditions immune thrombocytopenia (ITP)
• Lupus 
• Rheumatoid arthritis
• Leukaemia and lymphoma lead to bone marrow damage, thus reducing the platelet production.
• Chemotherapy and radiation therapy
• Already existing bacterial infections
• Use of alcohol  
• Exposure to toxic chemicals like arsenic, benzene, and pesticides 
• Medications like Heparin (a blood thinner), medications for seizures and heart disorders, and antibiotics used to treat bacterial infections can all have an impact on platelet levels.¹

Diagnosis of Low Platelet Count

Diagnostic methods for low platelet count: 

1. Physical examination: A physical examination will be performed by medical professionals.

• They will look for bruising, rashes, and other signs of thrombocytopenia. 
• Your medical history will be questioned, along with any drugs you are now taking.

2. They might do tests like:

• Complete blood count (CBC): Healthcare professionals will measure your white and red blood cell, platelet, and haemoglobin levels.
• Using a microscope, healthcare professionals will look at your platelets in a peripheral blood smear.
• Prothrombin time (PT) and partial thromboplastin time (PTT) assays determine the time taken by the blood to clot.
• Bone marrow biopsy: Your healthcare practitioner might do a bone marrow biopsy if blood tests reveal a low platelet count.¹

Treatment of Low Platelet Count

Healthcare providers can often improve platelet counts by addressing the underlying cause, which may involve changes in medication. Additional treatment options may include:

1. Diet and medicine: 

• Mediterranean diet: Adopting a Mediterranean diet helps keep platelet counts in the normal range, which is important for reducing the risk of chronic diseases.
  • It lowers the chances of developing thrombocytopenia, a condition characterized by low platelet count.
  • It lessens the link between changes in platelet count and the risk of mortality. ⁷
• Steroids: The doctor might prescribe steroids to help increase platelet production.

2. Medical procedures: 

• Blood transfusion: In cases of very low platelet levels, a healthcare provider may administer a blood transfusion to temporarily raise platelet levels for approximately three days.
• Splenectomy: This surgical procedure involves removing the spleen if tests indicate that it is trapping an excess number of platelets. It is important to note that individuals who undergo splenectomy have an increased risk of developing infections and may receive vaccinations to prevent them.¹

Also Read: How To Increase Platelet Count Naturally

Prevention of Low Platelet Count

It is important for your doctor to know if you have any medical conditions or take medications that increase your risk of developing thrombocytopenia. If you are not sure, consult your doctor to find out if there are any prescription drugs or activities you should avoid.

• There is currently no cure for genetic platelet disorders.
  • Many platelet problems are caused by other diseases or medications and cannot be prevented or avoided.
• Maintaining a healthy lifestyle, such as quitting smoking and limiting alcohol intake, may help reduce the chances of having low platelet levels.⁵
• As mentioned earlier, studies say adopting a Mediterranean diet helped to keep platelet counts in a healthy range, which is important for reducing the risk of various chronic diseases that tend to worsen over time.⁷

Complications of Low Platelet Count

Severe low platelet count can make patients more prone to:

• Severe internal bleeding: Low platelet count can lead to serious bleeding in the brain or gastrointestinal tract, which can be life-threatening.
• Increased risk of heart attack: Low platelet count may make it more difficult for the heart to receive an adequate blood supply.
• Pregnancy complications: Maintaining a pregnancy can be more challenging for women with low platelet count.
• Menorrhagia: Low platelet count can cause prolonged and heavy menstrual bleeding that lasts for more than a week.⁴

Also Read: What Causes High Red Blood Cell Count: Insights Into Hematological Disorders

Research Facts about Low Platelet Count

• Just before giving birth, moderate thrombocytopenia impact about 5% of pregnant women.¹
• In most age groups, women are more likely to have many platelet related disorders.⁵

FAQ’s

References

1. Thrombocytopenia: Symptoms, Stages & Treatment [Internet]. Available from: https://my.clevelandclinic.org/health/diseases/14430-thrombocytopenia

2. Thrombocytopenia: MedlinePlus Medical Encyclopedia [Internet]. Available from: https://medlineplus.gov/ency/article/000586.htm

3. Low Platelet Count or Thrombocytopenia | Cancer.Net [Internet]. Available from: https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/managing-physical-side-effects/low-platelet-count-or-thrombocytopenia

4. Platelet Disorders – Living With | NHLBI, NIH [Internet]. Available from: https://www.nhlbi.nih.gov/health/platelet-disorders/living-with

5. Platelet Disorders – Causes and Risk Factors | NHLBI, NIH [Internet]. Available from: https://www.nhlbi.nih.gov/health/platelet-disorders/causes

6.     National Center for Biotechnology Information [Internet]. Thrombocytopenia. 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542208/ 

7. Hernáez Á, Lassale C, Castro-Barquero S, Ros E, Tresserra-Rimbau A, Castañer O, et al.     Mediterranean diet-maintained platelet count within a healthy range and decreased thrombocytopenia-related mortality risk: A randomized controlled trial [Internet]. Nutrients. U.S. National Library of Medicine; 2021. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7915168/