Thrombocytopenia – Introduction, Mechanism, and Risk factors.

Introduction

People with thrombocytopenia have diminished platelets (Thrombocytes) count in the blood. Platelets are blood cells which help for clotting process. Normal platelets count value is from 150,000 and 450,000 per microliter (one-millionth of a liter). About two-third of platelets are released into the blood stream whereas the remaining are typically present in the spleen. Severe thrombocytopenia causes excessive bleeding.

Thrombocytopenia may occur due to the underlying medical conditions:

• Enlarged spleen may entrap high platelets in various conditions such as cirrhosis, myelofibrosis, and, gaucher disease.
• Heparin in the blood can be triggered by body immune system causes low platelet count. This condition is called as Heparin Induced Thrombocytopenia (HIT)

• Non-immune HIT is also pose a reason in which a mild decrease in blood platelets occur.

History

Osler, Hyam, and Bizzozero were found small particles in the blood flow, these were assumed to be bacteria or the red cell fragments. James homer Wright, identified that the platelets are distinct hematopoietic component arising from megakaryotes.

In 1903, William duke described low platelet count in 3 patients, those who were affected with hemorrhagic disease. He created a venous shunt from a healthy donor to a thrombocytopenic recipient and proved that platelet count could rise and bleeding would ceases.

Causes

• The onset of thrombocytopenia occurs when there is no enough production of blood cells in the bone marrow as in leukemia, lymphoma, aplastic anemia and some anemic conditions.
• Infection of Human immunodifficiency virus (HIV), Hepatitis C virus, and Epstein-Barr virus (Cause of mononucleosis) also results in thrombocytopenia.
• When there is massive blood transfusion platelets concentration in the blood may get diluted due to very low platelets in the stored blood.
• Drugs such as heparin, quinidine and diuretics.
• Few antibiotics also cause low platelet count some of them are rifampin, vancomycin, chloramphenicol and trimethoprim/sulfamethoxazole.
• Chemotherapy for leukemia also causes low platelet count in blood.
• Cardiopulmonary byepass surgery builds up thrombocytopenia.
• Disseminated intravascular coagulation within blood vessels, blood poisoning (septicemia) due to gram-negative bacteria, cancer, and traumatic brain damage.
• Bacterial infection of blood (septicemia).
• Hemolytic-uremic syndrome.
• Thrombotic thrombocytopenic purpura. In this disease condition small blood clots are formed unfortunately, using large number of platelets throughout the body.
• Some genetic conditions such as Wiskott-Aldrich and May-Hegglin syndromes lead to low platelet count.
• Our body destroys its own platelets in the case of autoimmune diseases such as immune thrombocytopenia (ITP)

Risk factors of Thrombocytopenia

• Pregnancy women develop mild thrombocytopenia. The exact cause is unknown.
• Exposure to toxic chemicals such as arsenic, benzene, and pesticides.
• Alcoholism- alcohol reduces the production of platelets.
• Taking foods that are low in iron, vitamin B12, or folate makes a temporary reduction in platelet count.
• Frequent blood transfusion and dialysis.

Symptoms

If the thrombocytopenia is mild it may not have symptoms and it can be detected only through routine blood tests for some other reasons. If a person has low platelet counts some of the signs and symptoms include:

• Petechiae (small reddish spots on skin due to the superficial bleeding into the skin)
• Fatigue
• Jaundice
• Purpura (easy or excessive bruising)
• Blood in stool or urine
• Enlarged spleen
• Nosebleeds
• Deep vein thrombosis
• Nonstop bleeding
• Unusual heavy menstrual bleeding
• Continuous bleeding from the gums or nose
• Prolonged bleeding from cuts
• Bloody or very dark vomit

Symptoms

 Complications of Thrombocytopenia

• After a cut or injury, excessive bleeding may occur that causes hemorrhage and major blood loss
• Dangerous internal bleeding can occur when the platelets fall below 10,000 platelets per liter, perhaps blood bleeding through your gastrointestinal tract (digestive system)
• In rare cases, severe thrombocytopenia may cause bleeding in brain which can be fatal
• Other complications may occur due to other underlying factors or conditions such as autoimmune thrombocytopenia leads to lupus may be associated with other complications of lupus

Diagnosis and test

Medical history: Your doctor may ask about factors, medical history and symptoms such as:

• Medication that you took, including over the counter medicines and whether you drunk beverages that contain quinine
• General eating habits
• Any family history of low platelets

Physical examination: Doctor will perform the physical examination to look for skin red spots, bruises, spots of blood on the skin and other signs of low platelets. Other signs of infections like fever or rashes will be checked.

The following tests may be done:

Blood test: The complete blood count test that measures the number of platelets, white blood cells and red blood cells in your blood. If the person has thrombocytopenia, the results of the test will show low platelets level.

Blood smear: Blood smear to see the appearance of the platelets under the microscope and to see how healthy they are.

Bone marrow tests: this test is to check the bone marrow is healthy or not and to make sure that bone marrow is producing enough blood cells. There are two bone marrow tests are bone aspiration and biopsy. For aspiration, your doctor will take a small amount of fluid from bone marrow by the needle. For a biopsy, your doctor will take a small sample of bone marrow tissue.

Other tests: Your doctor may recommend blood clot tests such as prothrombin time (PT) and Partial Thromboplastin Time (PTT) test to see whether your blood is clotting properly. Your doctor may suggest taking ultrasound to see whether you’re his or her spleen enlarged.

Treatment and medications

The treatment depends on the cause and severity of your condition. If your condition is mild, treatment is not needed. Treatments may include as follows:

Blood or platelet transfusion

Blood or platelet transfusion is needed when the condition is at high risk of bleeding. During the transfusion, your lost blood is replaced with platelets and red blood cells.

Splenectomy

Splenectomy is the surgery to remove the spleen. This can be done when your medicines don’t help with the condition. This surgery is mostly used for an adult with immune thrombocytopenia.

Medicines

Medicines are the first course of treatment. If you have immune thrombocytopenia, your doctor may prescribe drugs to increase your platelets are corticosteroids. These can be given through a vein or by mouth. One example of this type of medicine is prednisone.

Your doctor may prescribe immunoglobulins or medicines like rituximab to suppress your immune system. This can be given through a vein. Other medicines such as eltrombopag or romiplostim, to help your body make more platelets.

Home remedies

Prevention of Thrombocytopenia

 Condition can’t be prevented. But you can take steps to prevent the health problems that associated with thrombocytopenia.

• Avoid drinking alcohols, it will slow downs the platelet production
• Avoid activities and sports that may cause injury and cut that leads to heavy bleeding
• Use soft toothbrush to prevent bleeding from gums
• Avoid medicines that reduce your platelet count
• Try to avoid contact with the chemical that slows down the production of palates. Chemicals such as pesticides, arsenic, and benzene
• Before getting vaccinated for viruses talk with your doctor to avoid the vaccines that affect your platelet counts