Thrombocytopenia

Thrombocytopenia is the term for a reduced platelet (thrombocyte) count. A low platelet count can result from decreased production, increased utilization, or destruction, as well as from splenic sequestration. Thrombocytopenia should be considered, especially in patients with mucous membrane bleeding or petechial hemorrhages.

Causes of failed platelet production include aplastic and megaloblastic anemia, infection (including HIV), alcoholinduced bone marrow suppression, and bone marrow infiltration with leukemia or with myelodysplastic cells.

Causes of increased platelet destruction or utilization include idiopathic thrombocytopenic purpura, thrombotic thrombocytopenic purpura, and hemolytic-uremic syndrome; drugs, including heparin, quinidine, gold salts, rifampin, sulfa, oral diabetic agents, and ticlopidine; and states of intravascular coagulation (sepsis, metastatic cancer, traumatic brain damage, and obstetric complications such as HELLP and ARDS).

Causes of splenic sequestration should also be considered, including cirrhosis and mononucleosis with secondary splenomegaly, Gaucher's disease, and myelofibrosis with myeloid dysplasia.

Causes

Thrombocytopenia may be caused by infections in the fetus or newborn such as rubella, syphilis, and bacterial or viral infections. It can also develop when a mother's immune system produces antibodies against the baby's platelets. Some medications taken by the mother or given to the baby can cause thrombocytopenia.

Symptoms

• Gingival bleeding
• Prolonged bleeding after dental work
• Epistaxis
• Easy bruising
• Excessive menses
• Hematuria
• GI bleeding

Signs

• Multiple scattered petechiae, purpura, or ecchymosis
• Epistaxis
• Other bleeding

Treatment

If low platelet counts are caused by an enlarged spleen, removal of the spleen can help raise the platelet level, since the spleen is no longer there to capture the platelets. However, proper treatment for what causes the enlarged spleen is necessary as well.

Low platelet counts can indicate more serious conditions. If a dysfunctional immune system is found to be the cause for this condition, drugs like steroids or gamma globulin can be used to help maintain platelet levels in certain cases.

If low platelet levels are due to an abnormally low level of platelet production, transfusions of platelets can be given as well.

Prevention

Prevention depends on the specific cause.