Decreased platelets or thrombocytopenia: symptoms and treatment

The platelets are responsible for blood clotting along with other elements such as:

1. Fibrinogen
2. Coagulation factors.

It is therefore very important to keep the number of platelets within normal levels.

About 65% of platelets are found in circulating blood, about 35% in the spleen or other organs.

Human blood consists of three cell components:

• red blood cells (erythrocytes),
• white blood cells (leukocytes),
• platelets (platelets).

Platelets play an important role in the healing process of lesions and in the formation of blood clots during injuries.

They are irregularly shaped, microscopically small cells without a nucleus.

Platelets come from bone marrow cells called megakariocytes.

The normal range of platelet counts varies between 150,000 and 400,000 per μl (microliter).

Values that are slightly below or above this range can have dangerous consequences.

Causes of decreased platelets

Platelet inclusion in the spleen

The spleen is a small organ the size of a fist located just below the rib cage on the left side of the abdomen.

The spleen normally fights infections and filters unwanted substances from the blood.

Splenomegaly (enlargement of the spleen) caused by some disorders can:

1. include platelets,
2. Lead to the decrease of these cells in the blood.

In cirrhosis of the liver, the portal vein has difficulty in allowing appropriate blood flow to the liver, as there is a blockage of circulation.

The result is an increase in pressure in the portal vein (portal hypertension).

This also increases the pressure in the splenic vein and leads to splenomegaly.

Decreased platelet production

Platelets are produced in the bone marrow.

Diseases that affect the bone marrow, such as leukemia (blood cell tumor), multiple myeloma, and some types of anemia, can reduce the generation of new platelets.

In myeloproliferative syndrome (for example, myeloid leukemia), immature cells (myeloblasts) proliferate and accumulate in the bone marrow.

The bone marrow filled with myeloblasts decreases the production of red blood cells and platelets.

Menstrual periods that occur during the menstrual cycle can cause severe blood loss, leading to thrombocytopenia.

Viral infections (for example, mononucleosis, which can lead to spleen enlargement) can reduce the bone marrow’s ability to make platelets.

Chemically toxic substances, chemotherapy drugs and alcohol abuse can reduce the number of platelets.

Increased use of platelets

Some diseases can cause the consumption or destruction of platelets faster than they are generated. So there is a platelet deficiency in the blood flow. Some examples:

• Pregnancy can cause mild thrombocytopenia.
• Idiopathic thrombocytopenic purpura (ITP). In ITP, the immune system produces antibodies that mistakenly fight platelets. She is also immune thrombocytopenia The diagnosis of this condition is made by exclusion if the examination of the peripheral blood smear shows no other causes and the clotting is normal.
• Autoimmune diseases, in which the immune system fights healthy tissue, can cause thrombocytopenia. These include, for example, lupus and rheumatoid arthritis.
• Bacteria in the blood. Severe bacterial infections of the blood (bacteremia) can lead to the destruction of platelets. In this case, the patient also has a high fever.
• Thrombotic thrombocytopenic purpura (TTP) is a rare disease that occurs when small blood clots suddenly form throughout the body. This leads to a consumption of platelets in large quantities.
• Hemolytic uremic syndrome. This rare disease causes a sharp drop in platelets, destruction of red blood cells and impaired kidney function. Sometimes this occurs along with a bacterial infection with Escherichia coli, which can be ingested by eating raw or undercooked meat.
• Medication. Some drugs can reduce the number of platelets in the blood or disrupt the immune system that destroys platelets. Some examples are heparin, quinidine, quinine, sulfonamide antibiotics, interferon, anticonvulsants, chemotherapeutic agents and gold salts.

Decreased platelets in pregnancy

Even though women may have low platelets even before pregnancy, the development of this condition is common during pregnancy.

It is believed that this is due to the increase in blood plasma.

If the blood plasma increases, the number of cells present per milliliter of blood decreases.

Some women have low platelet counts in the third trimester (especially in the eighth and ninth months).

This condition is called gestational thrombocytopenia.

One of the problems associated with low platelets is that you can’t do epidural anesthesia before giving birth for pain relief.

Decreased platelets in children

In infants and young children, the most common cause of increased platelet destruction is idiopathic thrombocytopenic purpura.

Because celiac disease is an autoimmune disease, it can occur along with other autoimmune diseases, such as anemia or autoimmune thrombocytopenia.

The most appropriate therapy for thrombocytopenia with celiac disease is not certain because there is not enough statistical data, but in some cases a gluten-free diet can normalize platelet levels (hematologic manifestation of childhood celiac disease. Fisgin T, Yarali N, Duru F, Usta B, Kara A Acta Haematol. 2004; 111(4):211-4)).

Idiopathic thrombocytopenic purpura

This is a rare disease because there are very few patients who need treatment, about 2-3 new cases per year. The others do not require medical treatment.

This disease occurs when the body mistakenly identifies the platelets as foreign cells.

The body makes antibodies against the platelets, which are then destroyed by the immune system.

This leads to a sudden decrease in platelets.

Most children with ITP have a previous viral disease that triggered this abnormal immune response.

Often children with ITP have nosebleeds, mucosal bleeding and bleeding of the gums or other areas.

Premature babies are born with a number of slightly low platelets, but within 2 weeks their number rises to normal.

In children, hemolytic uremic syndrome, or HUS, is another common condition that leads to thrombocytopenia.

It arises after infection with a special strain of E. coli, which is a common cause of diarrhea and food poisoning. A child affected by HUS suffers from renal insufficiency and thrombocytopenia.

Symptoms of low platelets

One of the most obvious symptoms of low platelets is bleeding.

The nose, gums or cheeks inside the mouth bleed for no reason.

With a small injury, bleeding does not stop for a long time.

Possible is the formation of bleeding within the body tissues, which presents itself as:

1. Haematoma
2. Bruises.

The main symptom of internal bleeding due to purpura is the appearance of red spots or purple formations on the skin.

They are called bleeding petechiae.

Other symptoms include:

1. Fatigue
2. Easy occurrence of ecchymoses,
3. Insecurity
4. Fear of trauma.

Complications or effects of high or low platelet counts

The result of increased or decreased platelets can be fatal. Reasons for this are:

Low platelet count

The low platelet count or thrombocytopenia may be caused by insufficient production, increased destruction or platelet consumption.

This can lead to continued bleeding of an injury due to the lack of platelets that can heal the wound.

When to worry?

A platelet count below 30,000/μl can be dangerous.

Increased platelet count

An increased platelet count or thrombocytosis can be the result of increased production or ineffective destruction of old platelets by the organism.

Some diseases, lesions, medications, or surgical procedures can increase platelet production.

The increase in platelet count can lead to the formation of deep vein thrombosis and blood vessel occlusion. This causes:

1. Myocardial infarction
2. Stroke.

Diagnosis of thrombocytopenia

Usually, thrombocytopenia is detected by a routine blood test done for other reasons.

Platelets are a component of the large blood count, which also provides information about red and white blood cells.

The complete analysis of the other components from the complete blood count is important when evaluating low platelet counts. The complete blood count may indicate the presence of other blood disorders, such as:

1. erythrocytosis (increased number of red blood cells or hemoglobin),
2. leukopenia (decreased number of white blood cells),
3. leukocytosis (increased white blood cells); Leukocytes contain: monocytes, eosiniphiles, neutrophils, basophils or lymphocytes.

Aplastic anemia causes the reduction of all blood cells, so they are:

• erythrocytes,
• platelets decreased,
• White blood cells decreased (lymphocytes, monocytes, etc.).

These abnormalities may indicate problems in the bone marrow that lead to thrombocytopenia.

Red blood cells of abnormal or broken form (schistocytes) observed in the blood smear may be an indication of HELLP, TTP (thrombocytopenic purpura) or HUS.

Another examination from the complete blood count is the mean platelet volume, or MPV, an estimate of the average size of platelets.

A low number of MTV in the blood indicates a problem in the production of platelets, while an increased number may indicate increased destruction.

It’s important to do other blood tests as well, including the comprehensive metabolic panel, clotting, and urinalysis.

Some anomalies from this study are typical of:

1. cirrhosis of the liver (platelets decreased and bilirubin increased),
2. renal insufficiency (with azotemia and high creatinine),
3. Other pathologies.

What to do? Therapy for decreased platelets

Mild thrombocytopenia

Many cases of mild thrombocytopenia do not require therapy. The disease passes by itself.

In pregnant women, mild thrombocytopenia improves after childbirth.

High-grade thrombocytopenia

Treatment options for thrombocytopenia may include:

Treatment of the disease underlying thrombocytopenia. If the doctor can identify the disease and treat the disease causing the thrombocytopenia, the signs and symptoms of the affected person may improve.

Treatment of idiopathic thrombocytopenic purpura includes drugs that block the antibodies to the platelets, such as corticosteroids.

Dexamethasone is indicated mainly because it has a hemostatic effect.

Corticosteroids must not be taken for several months, otherwise they will have serious side effects.

In 15-30% of cases, patients respond to corticosteroid therapy. (Therapy of chronic idiopathic thrombocytopenic purpura in adults. Berchtold P, McMillan R – Blood. 1989 Nov 15; 74(7):2309-17.)

Blood transfusions. If the platelet level is too low, the doctor must substitute the blood loss with a transfusion of red blood cells and platelets.

If corticosteroids do not help, the doctor must consider surgical removal of the spleen (splenectomy) or use stronger drugs that suppress the immune system.

Rituximab has a 30-40 percent chance of getting acceptable platelet counts.

The ideal candidates for taking this drug are young women in whom platelet drops began less than 2 years ago.

Results of treatment with rituximab are not always immediate, you have to wait 2-3 months to evaluate the effect.

Splenectomy resolves about 70-80% of cases (chronic idiopathic thrombocytopenic purpura. George JN, el-Harake MA, Raskob GE – N Engl J Med. 1994 Nov 3; 331(18):1207-11.).

However, this includes risks of thrombus formation and a greater likelihood of developing infections.

In children, removal of the spleen is usually not done because this organ has an immune function and the toddler is thus exposed to a greater risk of infection.

However, patients with other medical conditions or respiratory problems are not eligible for spleen removal or treatment with rituximab.

There are some new drugs, called: thrombopoietin receptor agonists or thrombopoietin mimetics (TPO-m). (Eltrombopag, Romiplostim)

These drugs act like hormones that stimulate the production of platelets in the bone marrow.

They do not have serious side effects, however, the patient must take this drug for a long time.

The drug is used in patients who cannot or do not want to undergo any other therapy.

In some cases, some patients may be able to solve their problem and stop therapy.

The effectiveness of TPO is 80%.

People taking this medication may have minor bleeding but do not risk severe bleeding.

Home remedies for low platelets

Avoid activities that could lead to injury. Contact sports such as boxing and football are causes of excessive bleeding risks.

Enjoy alcohol only in moderation, because it can reduce the production of platelets in the body.

Be careful when taking non-prescription medications. Over-the-counter painkillers that can affect the function of platelets are, for example, aspirin and ibuprofen (Moment, Brufen and others).

What should you eat? Diet and nutrition for low platelets

According to the Gluten Free Society, gluten causes vitamin B12 deficiency.

Vitamin B12 is used for the production of:

1. red blood cells,
2. white blood cells,
3. Platelet.

The diet recommended by naturopathy consists of natural foods, except:

1. Cereal products containing gluten (bread, pasta, crackers, breadsticks, biscuits, pizza, kamut, spelt, barley and oats).
2. milk and dairy products,
3. Other processed products,
4. sweets and supplements containing maltodextrin,
5. Stimulating drinks (coffee, tea) and beer.

Some theories of naturopathy advise against meat and animal proteins because the anatomy of the human gut is similar to that of fruit-eating animals (such as chimpanzees) and different from carnivores, which have short intestines.

The digestion of meat in humans is very slow and the result is slag production (putrescine, cadaverine, etc.).

However, according to the blood type diet and paleo diet, meat is a basic food for the human who has been a hunter in his past.

According to the blood type diet, cereals can also cause leukemia.

• Enlargement of the spleen or splenomegaly
• Symptoms of polycythemia
• Complete blood count in the blood test