Causes of Low Platelet Count & Tips for Improving Them   

Introduction

Platelets play a crucial role in blood clotting, and having inadequate platelet counts can lead to issues like difficulty in stopping bleeding¹. Low platelet count, also known as thrombocytopenia, can occur due to many factors. In this article, we will delve into the production, functions, and health issues associated with platelets; what triggers a low platelet count; and how it’s diagnosed. We will also discuss management options for thrombocytopenia, including simple lifestyle changes. 

What Is Low Platelet Count (Thrombocytopenia)?

Definition

A low platelet count is defined as less than 150,000 platelets per microliter in the bloodstream².  

Role of platelets in blood clotting

Platelets play an essential role in stopping bleeding by helping the blood form clots. When a blood vessel is injured, platelets quickly gather at the site and stick together to form a plug, avoiding further blood loss.  

Normal platelet count

Normal platelet count ranges between 150,000 and 450,000 platelets per microliter of blood¹.  

Symptoms of Low Platelet Count

This section outlines common signs that may appear when a person has a low platelet count.  

• Petechiae: One key sign of low platelet count is petechiae formation. Petechiae are small, reddish-purple spots that appear on the skin due to minor bleeding under the skin.  
• Easy Bruising (Purpura): People with low platelet levels may bruise easily, even after mild bumps. These patches of discolouration, called purpura, also result from bleeding beneath the skin and are larger than petechiae.  
• Bleeding: Bleeding may occur from the gums or nose. There may also be blood in the urine or stools. These symptoms should not be ignored and require medical attention. 
• Prolonged bleeding from cuts: Minor injuries may bleed for a longer time than usual due to reduced clotting ability, which may delay wound healing.  
• Heavy menstrual bleeding: Women with low platelet counts may experience heavier-than-usual menstrual bleeding^1,3.  

When to See a Doctor?

Timely medical intervention is key in thrombocytopenia management⁴. 

• Symptoms that warrant medical attention: If you notice any symptoms like easy bruising, petechiae, prolonged bleeding, or any of the other symptoms mentioned above, consult your doctor for evaluation.  
• Uncontrolled bleeding as a medical emergency: If you have profuse bleeding that cannot be stopped by applying pressure to the injury, seek immediate medical help.  

To my knowledge, severe internal bleeding may be more likely to occur in those with severe thrombocytopenia (or low platelet count). Bleeding in the brain or gastrointestinal tract might result from thrombocytopenia. Bleeding in the brain is a potentially fatal condition³.

Dr. Siddharth Gupta, B.A.M.S, M.D

Causes of Low Platelet Count

A low platelet count can occur due to various factors. These may include:  

1. Enlarged spleen (trapped platelets)

An enlarged spleen, a condition called splenomegaly, can trap too many platelets. This reduces the number circulating in the bloodstream⁵. 

2. Decreased production of platelets

The bone marrow produces platelets. Any condition that affects the marrow can lower platelet levels. These conditions include:  

• Bone marrow problems: Certain illnesses like leukaemia or aplastic anaemia can disrupt the bone marrow, leading to a fall in platelet production.  
• Infections: Certain infections, like hepatitis C or HIV, can lower platelet counts.  
• Genetic causes: Inherited disorders like Wiskott-Aldrich syndrome or May-Hegglin anomaly can also interfere with platelet production².  

3. Increased breakdown of platelets

In some cases, the body destroys platelets faster than they are made. This may occur due to:   

• Immune system disorders: Autoimmune diseases like immune thrombocytopenic purpura (ITP), lupus, or rheumatoid arthritis can cause the immune system to attack the platelets mistakenly.  
• Medications and substances: Certain medicines like heparin can lower platelet levels either by destroying them or by slowing production. Excessive alcohol use may also contribute^1,2. 

Diagnosis of Low Platelet Count

Diagnosing thrombocytopenia usually involves a combination of clinical assessment and laboratory tests. These may include: 

1. Physical examination

Your doctor will examine your skin for signs of unusual bleeding, such as bruising or petechiae. They may also check your abdomen for an enlarged spleen.  

2. Medical history

You will be asked about any previous illnesses, ongoing health conditions, or medications that could affect platelet levels.  

3. Blood tests

A CBC test is used to measure the number of platelets and other blood cells. This is usually the first step in identifying thrombocytopenia⁶. 

4. Ultrasound

If an enlarged spleen is suspected, an abdominal ultrasound may be recommended. This helps your doctor assess the size and condition of the spleen⁵. 

5. Bone marrow aspiration and biopsy

To better understand the cause of low platelet production, your doctor may collect a small sample of bone marrow fluid (aspiration) or tissue (biopsy). This test provides detailed information about how blood cells are being produced in your body⁷. 

Due to its antioxidant qualities, dragon fruit might help people with dengue increase their platelet counts. For this reason, doctors may advise dengue patients to eat dragon fruit. However, there is lack of enough large scale studies to back this up¹¹.

Dr. Smita barode, B.A.M.S, M.S.

Management of Low Platelet Count

Managing thrombocytopenia involves treating the underlying cause while also addressing the symptoms. Here are some common treatment approaches used to manage low platelet count, depending on the underlying cause: 

1. Medication adjustments

If low platelet counts have been caused by medications, your doctor may adjust the medicine dose or switch to an alternative medicine¹. 

2. Infections

When infections such as viral illnesses are the cause, managing the infection may help restore platelet levels. 

3. Immune system disorders

If your immune system is mistakenly destroying platelets (as seen in conditions like ITP), your doctor may prescribe medicines to suppress this immune response and support platelet recovery³. 

4. Blood transfusions

In cases of very low platelet count or severe bleeding, blood transfusions may be required to replace lost blood components, such as red blood cells or platelets³. 

5. Platelet transfusions

Platelet transfusions may be needed when platelet counts are dangerously low or if there is active bleeding. Platelet transfusions may help improve blood clotting temporarily¹.  

6. Medications to increase platelet production

Certain medicines, such as prednisone (a steroid), avatrombopag, romiplostim, and eltrombopag, may be prescribed to stimulate the body to produce more platelets. In individuals with immune-related thrombocytopenia, medicines like rituximab and immunoglobulins may be used to stop the destruction of platelets by the immune system^1,3.  

7. Splenectomy

In individuals with chronic or severe thrombocytopenia, such as ITP, removing the spleen surgically (splenectomy) may be recommended when other treatments are ineffective. Splenectomy can help increase platelet counts by reducing the destruction of platelets. 

Lifestyle Changes

Adopting simple lifestyle changes along with medical treatment may help support overall health and reduce risks related to a low platelet count.  

• Avoid injuries: Skip activities that may lead to injury. These include contact sports. Make sure to take all safety precautions³.  
• Review medications: Speak to your doctor about any prescribed medicines or over-the-counter supplements you are taking as some of them may be affecting your platelet levels or interfering with treatment³.  
• Follow a healthy lifestyle:  A balanced diet, regular physical activity, and adequate sleep may support your immune system and help maintain healthy blood cells.  
• Avoid alcohol: Excessive alcohol can impair bone marrow function and reduce platelet production. It’s advisable to limit or avoid alcohol consumption³. 

Your doctor might advise against flossing until your platelet counts stabilise. You are advised to rinse and wash your teeth after every meal. To avoid bleeding gums, use an extra-soft toothbrush. Use hot water to make your toothbrush softer before each usage. Use extreme caution and gentleness when flossing. Steer clear of readily bled areas. Apply petroleum jelly or lip balm to keep lips hydrated and stop them from breaking. Consult your medical team before receiving any dental care¹⁰.

Dr. Rajeev Singh, BAMS

Complications of Low Platelet Count

If left untreated, a low platelet count can lead to serious complications, some of which may be life-threatening.  

• Severe bleeding: A very low platelet count increases the risk of uncontrolled or heavy bleeding, even from minor injuries. This may require urgent medical attention³.  
• Bleeding in the brain: In rare cases, low platelet levels may result in internal bleeding, including bleeding in the brain. This is a medical emergency and can be fatal if not treated promptly.  
• Prolonged bleeding during surgery: Low platelet counts may cause excessive bleeding during or after surgery, which can complicate the recovery process⁸. 

Screening

Early detection of thrombocytopenia through routine checks and regular monitoring can help avoid complications and guide timely treatment.  

• Routine blood tests: Regular blood tests, like CBCs, can help detect low platelet levels early, often before symptoms develop.  
• Monitoring high-risk individuals: People with known risk factors for thrombocytopenia, such as chronic illness, family history, or taking certain medications, should undergo regular medical checks to monitor platelet levels⁹. 

Conclusion

Maintaining a healthy platelet count is essential for avoiding excessive bleeding and supporting your body’s natural healing processes. Early recognition of symptoms like easy bruising, petechiae or prolonged bleeding and getting promptly evaluated can help identify the underlying cause and guide appropriate treatment. By combining professional care with simple lifestyle measures, most people with thrombocytopenia can effectively manage their condition and reduce the risk of complications.   

Frequently Asked Questions (FAQs)

References

1. Thrombocytopenia [Internet]. NIH. Cited 2025 Jul 09. Available from: https://www.nhlbi.nih.gov/health/thrombocytopenia 
2. Jinna S, Khandhar PB. Thrombocytopenia. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542208/ 
3. Thrombocytopenia [Internet]. Cleveland Clinic. Cited 2025 Jul 09. Available from: https://my.clevelandclinic.org/health/diseases/14430-thrombocytopenia 
4. Thrombocytopenia [Internet]. UC Davis Health. Cited 2025 Jul 09. Available from:  https://health.ucdavis.edu/conditions/blood-disorders/thrombocytopenia 
5. Chapman J, Goyal A, Azevedo AM. Splenomegaly. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430907/ 
6. Ashworth I, Thielemans L, Chevassut T. Thrombocytopenia: the good, the bad and the ugly. Clin Med (Lond). 2022 May;22(3):214-217. doi: 10.7861/clinmed.2022-0146. https://pubmed.ncbi.nlm.nih.gov/35584828/  
7. Blood Tests [Internet]. NIH. Cited 2025 Jul 09. Available from: https://www.nhlbi.nih.gov/health/blood-tests 
8. Ashoub A, Lakshmanan S, Luckraz H. Cardiac surgery in a patient with severe thrombocytopenia: how low is too low? Ann Card Anaesth. 2013 Jul-Sep;16(3):215-7. doi: 10.4103/0971-9784.114258. https://pubmed.ncbi.nlm.nih.gov/23816678/
9. Martínez-Carballeira D, Bernardo Á, Caro A, Soto I, Gutiérrez L. Pathophysiology, Clinical Manifestations and Diagnosis of Immune Thrombocytopenia: Contextualization from a Historical Perspective. Hematol Rep. 2024 Apr 3;16(2):204-219. doi: 10.3390/hematolrep16020021. https://pubmed.ncbi.nlm.nih.gov/38651450/ 
10. Canadian Cancer Society. Low platelet count (thrombocytopenia) [Internet]. Toronto (ON): Canadian Cancer Society; [cited 2025 Aug 22]. Available from: https://cancer.ca/en/treatments/side-effects/low-platelet-count
11. Nishikito DF, Borges ACA, Laurindo LF, Otoboni AMMB, Direito R, Goulart RA, Nicolau CCT, Fiorini AMR, Sinatora RV, Barbalho SM. Anti-inflammatory, antioxidant, and other health effects of dragon fruit and potential delivery systems for its bioactive compounds. Pharmaceutics. 2023 Jan 3;15(1):159. doi:10.3390/pharmaceutics15010159. PMID:36678789; PMCID:PMC9861186. https://pmc.ncbi.nlm.nih.gov/articles/PMC9861186/

Disclaimer: The information provided here is for educational/awareness purposes only and is not intended to be a substitute for medical treatment by a healthcare professional and should not be relied upon to diagnose or treat any medical condition. The reader should consult a registered medical practitioner to determine the appropriateness of the information and before consuming any medication. PharmEasy does not provide any guarantee or warranty (express or implied) regarding the accuracy, adequacy, completeness, legality, reliability or usefulness of the information; and disclaims any liability arising thereof. 

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