What You Need to Know About Living With Low Platelets

Platelets are small cells circulating in your bloodstream that affix themselves to the wall of a blood vessel following injury. They are specifically designed for clotting; they clump together to prevent bleeding. If you have low platelets in your blood, known as thrombocytopenia, your ability to form clots and stop bleeding may be impaired. It's important that you're aware of how your condition affects your overall health and what you can do to stay well.

Your platelets are analyzed during a complete blood count (CBC) test, which is a standard panel of bloodwork. Platelet count is one of the measures the CBC delivers. Here is the normal range and concerning levels of low platelets:

Thrombocytopenia may be hereditary or caused by several circumstances that result in your blood platelet count falling below normal levels.

While you may have ample platelets being produced, these possible causes of thrombocytopenia can destroy them, reducing your levels:

• Autoimmune conditions: Diseases such as lupus and rheumatoid arthritis may cause immune thrombocytopenia as the immune system starts to attack itself, destroying platelets in the process.
• Bacterial blood infections: Bacteremia, or a bacterial infection affecting the blood, may destroy platelets.
• Medications: Certain classes of medications called anticoagulants, for example, heparin, may cause platelet destruction by triggering your immune system to destroy them.

Thrombocytopenia can also result when your body simply isn't making an adequate number of platelets. Possible causes include:

• Pregnancy: Gestational thrombocytopenia is a fairly common condition during the third trimester due to increased blood dilution, as blood volume continues to increase and platelet counts fail to increase at the same rate. It's important to note that this decline is usually not associated with risk for serious bleed.
• Chemotherapy and radiation: These treatments are highly effective at killing cancer cells, but unfortunately, they are unable to distinguish between cancer cells and healthy ones. Chemotherapy and radiation particularly target cells that reproduce quickly, such as those in bone marrow. Cancer treatments may unintentionally kill the cells in bone marrow that are dedicated to producing platelets, resulting in thrombocytopenia.
• Leukemia: Another cause of thrombocytopenia may be the effect of blood cancer itself on the marrow. If bone marrow is invaded by cancer cells, the healthy cells may get crowded out by the cancer cells, ultimately affecting the production of platelets.
• Nutritional deficiencies: As with anemia, iron deficiency or vitamin deficiencies (B12, folate) can lead to low platelet counts, since the body doesn't have the basic nutrients to create them.
• Viral infections: Certain viral infections such as hepatitis C or HIV may result in decreased production of platelets.
• Heavy alcohol use: Because heavy alcohol consumption often results in malnutrition, you may be unable to form new blood platelets due to bone marrow abnormalities. Also, alcohol in of itself has a toxic effect on the bone marrow.

Several conditions may result in an enlarged spleen, which is responsible for storing up to one-third of the body's platelets at any time under normal conditions. An enlarged spleen may trap a larger number of platelets, not allowing them to escape into circulation.

If you have a low platelet count, you may experience a variety of symptoms. Call your doctor if any of the following issues increase in frequency, severity, or become worrisome to you:

• Easy bruising called purpura
• Tiny red spots on your skin called petechiae
• Excessive bleeding following even minor injuries
• Pain in your joints, particularly large joints like the knees and hips.
• Frequent nose bleeds
• Bleeding from the mouth or gums
• Blood in your urine or stool
• Headaches

There are several steps you can follow to avoid complications from low platelets; specifically working to minimize the risk of bleeding wherever possible.

• Avoid medications that contain aspirin, anti-inflammatories (like ibuprofen), or blood thinners, unless your healthcare professional recommends otherwise. Ask your pharmacist if you are unsure.
• Use an electric razor to shave, which may result in fewer nicks and cuts.
• Use extra care when working with sharp objects such as knives or scissors, so as not to accidentally cut yourself.
• Avoid contact sports​ to minimize the potential risk of injury and bleeding.
• Use an extra-soft toothbrush and perform diligent mouth care to reduce gum inflammation, as inflamed gums bleed more easily when flossing. Avoid flossing when your platelet count gets very low.
• Blow your nose gently so as not to trigger a nose bleed.
• Limit or avoid drinking alcohol.

Bleeding can become a very serious concern in someone with a low platelet count. If you begin bleeding, follow these steps and contact your care provider:

• Have a seat or lie down. Try to remain calm.
• Apply pressure to the wound if you can see it.
• Apply an ice pack to the site to slow the bleeding.
• If the wound is on an arm or leg, elevate the limb above the level of your heart.
• If you notice blood in your urine, keep drinking increased fluids and report to your doctor.
• If you notice blood in your vomit, take anti-nausea and stomach antacids as directed by your doctor.
• If you are bleeding vaginally or having your period, do not use tampons. Keep track of how many sanitary pads you are using and note any clots.

A low blood platelet count will often return to a normal level if the cause can be clearly identified and treated. This allows your bone marrow to recover normal function, such as post-pregnancy or post-cancer treatment, though the timeline will differ for everyone.

However, in some cases, a platelet transfusion may be warranted to prevent complications from bleeding. If this is required, you can expect to receive the platelets through an infusion into your vein.

If an autoimmune condition is causing your thrombocytopenia, you may be prescribed an immune-suppressant medication to help cease platelet destruction.

If a reaction to another medication is causing your thrombocytopenia, you may be placed on a different medication by your prescribing physician.

Low platelets, or thrombocytopenia, are a common side effect of blood cancers and their treatment, but may also be a result of autoimmune diseases, pregnancy, heavy alcohol consumption or certain medications. As a result of thrombocytopenia, you may experience frequent or excessive bleeding. It is important to do your best to avoid injury to prevent complications from occurring.