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When your blood has too few platelets, mild
to serious bleeding can occur. Bleeding can occur inside your body (internal
bleeding) or underneath your skin or from the surface of your skin (external

A normal platelet count in adults ranges
from 150,000 to 450,000 platelets per microliter of blood. A platelet count of
less than 150,000 platelets per microliter is lower than normal. If your blood
platelet count falls below normal, you have thrombocytopenia.

However, the risk for serious bleeding
doesn't occur until the count becomes very low—less than 10,000 or 20,000
platelets per microliter. Mild bleeding sometimes occurs when the count is less
than 50,000 platelets per microliter.

Many factors can cause a low platelet
count, such as:

-- The body's bone marrow doesn't make enough

-- The bone marrow makes enough platelets, but
the body destroys them or uses them up.

-- The spleen holds on to too many platelets.
The spleen is an organ that normally stores about one-third of the body's
platelets. It also helps your body fight infection and remove unwanted cell

-- A combination of the above factors.

-- How long thrombocytopenia lasts depends on
its cause. It can last from days to years.

The treatment for this condition also
depends on its cause and severity. Mild thrombocytopenia often doesn't require
treatment. If the condition causes or puts you at risk for serious bleeding,
you may need medicines or blood or
platelet transfusions. Rarely, the spleen may need to be removed.

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  1. 1. Fitango Education Health Topics Thrombocytopenia
  2. 2. OverviewWhen your blood has too few platelets, mildto serious bleeding can occur. Bleeding can occurinside your body (internalbleeding) or underneath your skin or from thesurface of your skin (external 1
  3. 3. Overviewbleeding).A normal platelet count in adults rangesfrom 150,000 to 450,000 platelets per microliter ofblood. A platelet count ofless than 150,000 platelets per microliter is lowerthan normal. If your blood 2
  4. 4. Overviewplatelet count falls below normal, you havethrombocytopenia.However, the risk for serious bleedingdoesnt occur until the count becomes very low—less than 10,000 or 20,000platelets per microliter. Mild bleeding sometimesoccurs when the count is less 3
  5. 5. Overviewthan 50,000 platelets per microliter.Many factors can cause a low plateletcount, such as:-- The bodys bone marrow doesnt make enoughplatelets. 4
  6. 6. Overview-- The bone marrow makes enough platelets, butthe body destroys them or uses them up.-- The spleen holds on to too many platelets.The spleen is an organ that normally stores aboutone-third of the bodys 5
  7. 7. Overviewplatelets. It also helps your body fight infection andremove unwanted cellmaterial.-- A combination of the above factors.-- How long thrombocytopenia lasts depends on 6
  8. 8. Overviewits cause. It can last from days to years.The treatment for this condition alsodepends on its cause and severity. Mildthrombocytopenia often doesnt requiretreatment. If the condition causes or puts you atrisk for serious bleeding, 7
  9. 9. Overviewyou may need medicines or blood orplatelet transfusions. Rarely, the spleen may needto be removed. 8
  10. 10. CausesMany factors can cause thrombocytopenia (alow platelet count). The condition can be inheritedor acquired."Inherited" means your parents pass the gene forthe condition to 9
  11. 11. Causesyou. "Acquired" means you arent born with thecondition, but youdevelop it. Sometimes the cause ofthrombocytopenia isnt known.In general, a low platelet count occursbecause: 10
  12. 12. Causes-- The bodys bone marrow doesnt make enoughplatelets.-- The bone marrow makes enough platelets, butthe body destroys them or uses them up.-- The spleen holds on to too many platelets. 11
  13. 13. Causes-- A combination of the above factors also maycause a low platelet count. 12
  14. 14. Causes **The Bone Marrow Doesnt Make EnoughPlatelets**Bone marrow is the sponge-like tissueinside the bones. It contains stem cells thatdevelop into red blood cells, 13
  15. 15. Causes **The Bone Marrow Doesnt Make Enoughwhite blood cells, and platelets. When stem cellsare damaged, they dont growinto healthy blood cells.Many conditions and factors can damage stemcells. 14
  16. 16. Causes **Cancer**Cancer, such as leukemia (lu-KE-me-ah) orlymphoma (lim-FO-ma), can damage the bonemarrow and destroy blood stem cells.Cancer treatments, such as radiation andchemotherapy, also destroy the stem 15
  17. 17. Causes **Cancer**cells.**Aplastic Anemia**Aplasticanemia is a rare, serious blood disorder in whichthe bone marrowstops making enough new blood cells. This lowersthe number of platelets in 16
  18. 18. Causes **Cancer**your blood.**Toxic Chemicals**Exposure to toxic chemicals—such aspesticides, arsenic, and benzene—can slow theproduction of platelets. 17
  19. 19. Causes **Medicines**Some medicines, such as diuretics andchloramphenicol, can slow the production ofplatelets. Chloramphenicol (anantibiotic) rarely is used in the United States. 18
  20. 20. Causes **Medicines**Common over-the-counter medicines, such asaspirin or ibuprofen, also can affect platelets. 19
  21. 21. Causes **Alcohol**Alcohol also slows the production ofplatelets. A temporary drop in the platelet count iscommon among heavydrinkers, especially if theyre eating foods that arelow in iron, vitamin B12, 20
  22. 22. Causes **Alcohol**or folate.**Viruses**Chickenpox, mumps, rubella, Epstein-Barrvirus, or parvovirus can decrease your plateletcount for a while. People whohave AIDS often develop thrombocytopenia. 21
  23. 23. Causes **Genetic Conditions**Some genetic conditions can cause lownumbers of platelets in the blood. Examplesinclude Wiskott-Aldrich andMay-Hegglin syndromes. 22
  24. 24. Causes **The Body Destroys Its Own Platelets**A low platelet count can occur even if thebone marrow makes enough platelets. The bodymay destroy its own platelets dueto autoimmune diseases, certain medicines,infections, surgery, pregnancy, and 23
  25. 25. Causes **The Body Destroys Its Own Platelets**some conditions that cause too much bloodclotting.**Autoimmune Diseases**Autoimmune diseases occur if the bodysimmune system mistakenly attacks healthy cells inthe body. If an autoimmune 24
  26. 26. Causes **The Body Destroys Its Own Platelets**disease destroys the bodys platelets,thrombocytopenia can occur.One example of this type of autoimmunedisease is immunethrombocytopenia(ITP). ITP is a bleeding disorderin which the blood 25
  27. 27. Causes **The Body Destroys Its Own Platelets**doesnt clot as it should. An autoimmune responseis thought to cause mostcases of ITP.Normally, your immune system helps yourbody fight off infections and diseases. But if youhave ITP, your immune system 26
  28. 28. Causes **The Body Destroys Its Own Platelets**attacks and destroys its own platelets. Why thishappens isnt known. (ITP alsomay occur if the immune system attacks your bonemarrow, which makesplatelets.)Other autoimmune diseases that destroy 27
  29. 29. Causes **The Body Destroys Its Own Platelets**platelets include lupus and rheumatoid arthritis.**Medicines**A reaction to medicine can confuse yourbody and cause it to destroy its platelets. Examplesof medicines that may 28
  30. 30. Causes **The Body Destroys Its Own Platelets**cause this to happen include quinine; antibioticsthat contain sulfa; and somemedicines for seizures, such asDilantin,®vancomycin, and rifampin. (Quinine isa substance often found in tonic water andnutritional health products.)Heparin is a medicine commonly used to 29
  31. 31. Causes **The Body Destroys Its Own Platelets**prevent blood clots. But an immune reaction maytrigger the medicine to causeblood clots and thrombocytopenia. This conditionis called heparin-inducedthrombocytopenia (HIT). HIT rarely occurs outsideof a hospital.In HIT, the bodys immune system attacks a 30
  32. 32. Causes **The Body Destroys Its Own Platelets**substance formed by heparin and a protein on thesurface of the platelets. Thisattack activates the platelets and they start to formblood clots.Blood clots can form deep in the legs (deep veinthrombosis), or they can break loose and travel tothe lungs (pulmonary 31
  33. 33. Causes **The Body Destroys Its Own Platelets**embolism).**Infection**A low platelet count can occur after bloodpoisoning from a widespread bacterial infection. Avirus, such as mononucleosisor cytomegalovirus, also can cause a low plateletcount. 32
  34. 34. Causes **Surgery**Platelets can be destroyed when they passthrough man-made heart valves, blood vesselgrafts, or machines and tubing usedfor bloodtransfusions or bypass 33
  35. 35. Causes **Surgery**surgery.**Pregnancy**About 5 percent of pregnant women developmild thrombocytopenia when theyre close todelivery. The exact cause isntknown for sure. 34
  36. 36. Causes **Surgery**Rare and Serious Conditions That CauseBlood ClotsSome rare and serious conditions can causea low platelet count. Two examples are thromboticthrombocytopenic purpura (TTP) and disseminated 35
  37. 37. Causes **Surgery**intravascular coagulation (DIC).TTP is a rare blood condition. It causesblood clots to form in the bodys small bloodvessels, including vessels in thebrains, kidneys, and heart. 36
  38. 38. Causes **Surgery**DIC is a rare complication of pregnancy,severe infections, or severe trauma. Tiny bloodclots form suddenly throughoutthe body.In both conditions, the blood clots use upmany of the bloods platelets. 37
  39. 39. Causes**The Spleen Holds On to Too Many Platelets**Usually, one-third of the bodys plateletsare held in the spleen. If the spleen is enlarged, itwill hold on to too manyplatelets. This means that not enough platelets willcirculate in the blood. 38
  40. 40. Causes**The Spleen Holds On to Too Many Platelets**An enlarged spleen often is due to canceror severe liver disease, such as cirrhosis (sir-RO-sis). Cirrhosis is a diseasein which the liver is scarred. This prevents it fromworking well.An enlarged spleen also might be due to a 39
  41. 41. Causes**The Spleen Holds On to Too Many Platelets**bone marrow condition, such as myelofibrosis (MI-eh-lo-fi-BRO-sis). With this condition,the bone marrow is scarred and isnt able to makeblood cells.National Heart Lung and Blood Insitute 40
  42. 42. RisksPeople who are at highest risk forthrombocytopenia are those affected by one of theconditions or factorsdiscussed in "WhatCauses Thrombocytopenia?" This includes peoplewho: 41
  43. 43. Risks-- Have certain types of cancer, aplasticanemia, or autoimmune diseases-- Are exposed to certain toxic chemicals-- Have a reaction to certain medicines-- Have certain viruses 42
  44. 44. Risks-- Have certain genetic conditionsPeople at highest risk also include heavyalcohol drinkers and pregnant women.National Heart Lung and Blood Institute 43
  45. 45. SymptomsMild to serious bleeding causes the mainsigns and symptoms of thrombocytopenia.Bleeding can occur inside your body(internal bleeding) or underneath your skin orfrom the surface of your skin 44
  46. 46. Symptoms(external bleeding).Signs and symptoms can appear suddenly orover time. Mild thrombocytopenia often has nosigns or symptoms. Many times,its found during a routine blood test. 45
  47. 47. SymptomsCheck with your doctor if you have anysigns of bleeding. Severe thrombocytopenia cancause bleeding in almost anypart of the body. Bleeding can lead to a medicalemergency and should betreated right away. 46
  48. 48. SymptomsExternal bleeding usually is the first signof a low platelet count. External bleeding maycause purpura (PURR-purr-ah) orpetechiae (peh-TEE-key-ay). Purpura are purple,brown, and red bruises. This 47
  49. 49. Symptomsbruising may happen easily and often. Petechiaeare small red or purple dots onyour skin.Other signs of external bleeding include:-- Prolonged bleeding, even from minor cuts 48
  50. 50. Symptoms-- Bleeding or oozing from the mouth or nose,especially nosebleeds or bleeding from brushingyour teeth-- Abnormal vaginal bleeding (especially heavymenstrual flow) 49
  51. 51. SymptomsA lot of bleeding after surgery or dentalwork also might suggest a bleeding problem.Heavy bleeding into the intestines or thebrain (internal bleeding) is serious and can be fatal.Signs and symptoms 50
  52. 52. Symptomsinclude:-- Blood in the urine or stool or bleedingfrom the rectum. Blood in the stool can appear asred blood or as a dark, tarrycolor. (Taking iron supplements also can causedark, tarry stools.) 51
  53. 53. Symptoms-- Headaches and other neurological symptoms.These problems are very rare, but you shoulddiscuss them with your doctor. 52
  54. 54. DiagnosisYour doctor will diagnose thrombocytopeniabased on your medical history, a physicalexam, and test results. Ahematologist also may be involved in your care.This is a doctor who 53
  55. 55. Diagnosisspecializes in diagnosing and treating blooddiseases and conditions.Once thrombocytopenia is diagnosed, yourdoctor will begin looking for its cause. 54
  56. 56. Diagnosis **Medical History**Your doctor may ask about factors that canaffect your platelets, such as:-- The medicines you take, including 55
  57. 57. Diagnosis **Medical History**over-the-counter medicines and herbal remedies,and whether you drink beveragesthat contain quinine. Quinine is a substance oftenfound in tonic water andnutritional health products.-- Your general eating habits, including the 56
  58. 58. Diagnosis **Medical History**amount of alcohol you normally drink.-- Your risk for AIDS, including questionsabout bloodtransfusions, sexual partners, intravenous (IV)drugs, and exposure to 57
  59. 59. Diagnosis **Medical History**infectious blood or bodily fluids at work.-- Any family history of low platelet counts. 58
  60. 60. Diagnosis **Physical Exam**Your doctor will do a physical exam to lookfor signs and symptoms of bleeding, such asbruises or spots on the skin. He orshe will check your abdomen for signs of anenlarged spleen or liver. You also 59
  61. 61. Diagnosis **Physical Exam**will be checked for signs of infection, such as afever.**Diagnostic Tests**Your doctor may recommend one or more ofthe following tests to help diagnose a low plateletcount. For more information 60
  62. 62. Diagnosis **Physical Exam**about blood tests, go to the Health Topics BloodTests article.**Complete Blood Count**A complete blood count (CBC) measures thelevels of red blood cells, white blood cells, andplatelets in your blood. For 61
  63. 63. Diagnosis **Physical Exam**this test, a small amount of blood is drawn from ablood vessel, usually inyour arm.If you have thrombocytopenia, the resultsof this test will show that your platelet count islow. 62
  64. 64. Diagnosis **Blood Smear**A blood smear is used to check theappearance of your platelets under a microscope.For this test, a small amountof blood is drawn from a blood vessel, usually inyour arm. 63
  65. 65. Diagnosis **Bone Marrow Tests**Bone marrowtests check whether your bone marrow is healthy.Blood cells,including platelets, are made in your bone marrow.The two bone marrow tests 64
  66. 66. Diagnosis **Bone Marrow Tests**are aspiration (as-pih-RA-shun) and biopsy.Bone marrow aspiration might be done tofind out why your bone marrow isnt makingenough blood cells. For this test,your doctor removes a sample of fluid bonemarrow through a needle. He or she 65
  67. 67. Diagnosis **Bone Marrow Tests**examines the sample under a microscope to checkfor faulty cells.A bone marrow biopsy often is done rightafter an aspiration. For this test, your doctorremoves a sample of bone marrowtissue through a needle. He or she examines thetissue to check the number and 66
  68. 68. Diagnosis **Bone Marrow Tests**types of cells in the bone marrow.**Other Tests**If a bleeding problem is suspected, you mayneed other blood tests as well. For example, yourdoctor may recommend PT and 67
  69. 69. Diagnosis **Bone Marrow Tests**PTT tests to see whether your blood is clottingproperly.Your doctor also may suggest an ultrasoundto check your spleen. An ultrasound uses soundwaves to create pictures of yourspleen. This will allow your doctor to see whetheryour spleen is enlarged. 68
  70. 70. Diagnosis **Bone Marrow Tests**National Heart Lung and Blood Institute 69
  71. 71. TreatmentTreatment for thrombocytopenia depends onits cause and severity. The main goal of treatmentis to prevent death anddisability caused by bleeding.If your condition is mild, you may not need 70
  72. 72. Treatmenttreatment. A fully normal platelet count isntnecessary to prevent bleeding,even with severe cuts or accidents.Thrombocytopenia often improves when itsunderlying cause is treated. People who inherit thecondition usually dont 71
  73. 73. Treatmentneed treatment.If a reaction to a medicine is causing alow platelet count, your doctor may prescribeanother medicine. Most peoplerecover after the initial medicine has beenstopped. For heparin-induced 72
  74. 74. Treatmentthrombocytopenia (HIT), stopping the heparin isntenough. Often, youll needanother medicine to prevent blood clotting.If your immune system is causing a lowplatelet count, your doctor may prescribemedicines to suppress the immune 73
  75. 75. Treatmentsystem.**Severe Thrombocytopenia**If your thrombocytopenia is severe, yourdoctor may prescribe treatments such asmedicines, blood or platelettransfusions, or splenectomy. 74
  76. 76. Treatment **Medicines**Your doctor may prescribe corticosteroids,also called steroids for short. Steroids may slowplatelet destruction. Thesemedicines can be given through a vein or bymouth. One example of this type of 75
  77. 77. Treatment **Medicines**medicine is prednisone.The steroids used to treat thrombocytopeniaare different from illegal steroids taken by someathletes to enhanceperformance.Your doctor may prescribe immunoglobulins 76
  78. 78. Treatment **Medicines**or medicines like rituximab to block your immunesystem. These medicines aregiven through a vein. He or she also may prescribeother medicines, such aseltrombopag or romiplostim, to help your bodymake more platelets. The former 77
  79. 79. Treatment **Medicines**comes as a tablet to take by mouth and the latteris given as an injectionunder the skin. 78
  80. 80. Treatment **Blood or Platelet Transfusions**Blood or platelet transfusions are used totreat people who have active bleeding or are at ahigh risk of bleeding. Duringthis procedure, a needle is used to insert anintravenous (IV) line into one of 79
  81. 81. Treatment **Blood or Platelet Transfusions**your blood vessels. Through this line, you receivehealthy blood or platelets.For more information about this procedure,go to the Health Topics BloodTransfusion article. 80
  82. 82. Treatment **Splenectomy**A splenectomy is surgery to remove thespleen. This surgery may be used if treatment withmedicines doesnt work. Thissurgery mostly is used for adults whohave immune 81
  83. 83. Treatment **Splenectomy**thrombocytopenia (ITP). However, medicines oftenare the first courseof treatment. 82
  84. 84. PreventionWhether you can prevent thrombocytopeniadepends on its specific cause. Usually thecondition cant be prevented.However, you can take steps to prevent healthproblems associated with 83
  85. 85. Preventionthrombocytopenia. For example:-- Avoid heavy drinking. Alcohol slows theproduction of platelets.-- Try to avoid contact with toxic chemicals. 84
  86. 86. PreventionChemicals such as pesticides, arsenic, and benzenecan slow the production ofplatelets.-- Avoid medicines that you know havedecreased your platelet count in the past. 85
  87. 87. Prevention-- Be aware of medicines that may affect yourplatelets and raise your risk of bleeding. Twoexamples of such medicines areaspirin and ibuprofen. These medicines may thinyour blood too much.-- Talk with your doctor about getting 86
  88. 88. Preventionvaccinated for viruses that can affect yourplatelets. You may need vaccinesfor mumps, measles, rubella, and chickenpox. Youmay want to have your childvaccinated for these viruses as well. Talk with yourchilds doctor about thesevaccines. 87