What You Need to Know About Living With Low Platelets

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Detail of a bruise on the thigh of a woman
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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.

What's Normal?

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:

  • A normal platelet count is considered between 150,000 and 450,000 platelets per microliter of blood.
  • A low platelet count is considered anywhere below 150,000 platelets per microliter.
  • Mild bleeding risk occurs with 50,000 platelets per microliter and below.
  • Serious bleeding risk occurs if platelet count drops as low as 10,000 to 20,000 platelets per microliter.

Causes

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

Increased Platelet Destruction

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 and Coumadin (warfarin) may cause platelet destruction as part of their primary action.

Decreased Platelet Production

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.
  • 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.
  • Anemia: Conditions affecting the creation of red blood cells, such as in the case of anemia, may also affect the creation of platelets.
  • 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.

Enlarged Spleen

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.

Symptoms

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
  • Excessive bleeding following even minor injuries
  • Pain in your joints
  • Blood in the white parts of your eyes, or changes in vision
  • Tiny red spots on your skin called petechiae
  • Frequent nose bleeds
  • Bleeding gums
  • Headaches

It is important to call your healthcare provider immediately if you have any of the following symptoms:

  • Headache, confusion, or dizziness
  • Blood when you cough or difficulty breathing
  • Blood in your urine, vomit, or bowel movements
  • Vaginal bleeding after menopause or unusually heavy vaginal bleeding

Managing Low Platelets

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 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

What to Do if Bleeding Starts

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.

Treatment

Usually, thrombocytopenia will resolve on its own once the underlying cause has been treated and your bone marrow recovers 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.

A Word From Verywell

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.

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Article Sources

  • Thrombocytopenia: Symptoms and Causes. Mayo Clinic. April 2018. https://www.mayoclinic.org/diseases-conditions/thrombocytopenia/symptoms-causes/syc-20378293

  • Thrombocytopenia National Heart, Lung, and Blood Institute (NHLBI). 2019. https://www.nhlbi.nih.gov/health-topics/thrombocytopenia

  • Aster RH. Drug-induced Thrombocytopenia. InPlatelets 2019 Jan 1 (pp. 725-739). Academic Press.