Thrombocytopenia: is it curable? See causes, treatment, symptoms

What is thrombocytopenia?

Thrombocytopenia is a condition in which there is a deficiency of platelets (thrombocytes) in the blood, essential cells for coagulation and the consequent stopping of bleeding. It is related to several causes.

The lack of platelets can lead to minor or severe bleeding that does not stop. They can occur inside or outside the body (internal or external bleeding). They can also happen in the tissues just under the skin, forming bruises.

The reference values ​​for platelet count in healthy adult individuals vary between 150,000 and 450,000 platelets per microliter of blood. Although levels below 150,000 are enough to characterize thrombocytopenia, bleeding occurs only when the levels are very low.

Mild bleeding can occur when the count reaches 50,000 platelets per microliter, while serious ones only occur when critical levels are reached (below 20,000 platelets per microliter).

In the International Classification of Diseases, 10th edition (ICD-10), thrombocytopenia is found by code D69.6, and is also called thrombocytopenia.

What are platelets and what is their use?

Platelets are the blood cells responsible for stopping bleeding. When there is an injury, these cells come together and form a clot, a kind of protective layer on the wound, which prevents the blood from continuing to flow out until the wound is healed.

Also called thrombocytes, platelets are formed in the bone marrow.

Causes

Thrombocytopenia occurs when:

  • The bone marrow cannot produce enough platelets;
  • The body destroys the platelets that are produced;
  • Some diseases cause clots using too many platelets, leaving the rest of the body in short supply;
  • The spleen stores many platelets;
  • A combination of all of the above factors.

All of this can happen due to inherited (genetic) or acquired conditions (diseases that develop during life). Understand better:

Bone marrow does not produce enough platelets

Bone marrow is a spongy tissue that exists inside the bones. Its function is to produce blood cells such as red and white blood cells and platelets. And you thinking that the bone was just for support, huh?

The production of this blood material is done by means of stem cells, which are capable of becoming any type of cell in the human body. There are conditions that affect the health of these cells and prevent them from developing to become healthy blood cells. Some of them are:

Cancer

Certain types of cancer directly affect the bone marrow, damaging stem cells. This is the case of leukemia and lymphomas, tumors that affect both blood circulation and the immune system.

In addition, the chemo and radiotherapy treatments used in these diseases are also capable of destroying stem cells.

Aplastic anemia

It is an extremely rare type of anemia , in which the bone marrow simply fails to make enough blood cells. It affects not only platelets, but also white and red blood cells.

Toxic substances

Certain toxic substances are able to slow down the production of cells by the bone marrow. Prolonged exposure to pesticides, arsenic and benzene are therefore risk factors for temporary thrombocytopenia.

Medicines

Some medications may end up reducing platelet production. Examples are diuretics, chloramphenicol (an antibiotic), acetylsalicylic acid ( Aspirin ) and ibuprofen .

Alcohol consumption

Alcohol also slows down the production of platelets, especially in people who suffer from alcoholism . These people may experience temporary thrombocytopenia, especially when their diets are low in nutrients important for the creation of blood cells, such as iron, vitamin B12 or folic acid .

Viral infections

Infections such as measles , rubella , mumps , infectious mononucleosis and parvovirus can temporarily reduce platelet counts. In patients with HIV , the reduction tends to last longer.

Genetic diseases

Some genetic diseases also affect the production of platelets. Examples are Wiskott-Aldrich syndrome (which causes congenital immunodeficiency) and May-Hegglin (characterized by the production of giant platelets and in smaller numbers).

Platelet destruction

Even if the bone marrow produces enough platelets, some conditions can cause these cells to be destroyed. Examples:

Autoimmune diseases

The autoimmune diseases occur when the immune system is responsible for defending the body against foreign bodies, is confused and starts to attack healthy tissues and cells of the body.

Some examples of autoimmune diseases that cause thrombocytopenia are lupus and rheumatoid arthritis .

The immune system can attack thrombocytes (or bone marrow) even when there is no autoimmune disease. For these cases, it is called autoimmune thrombocytopenia .

Medicines

Certain medications can cause the body to become confused and start destroying platelets. Some examples of remedies that do this are quinine, antibiotics derived from sulfanilamide, rifampicin and some epilepsy medications , such as vancomycin and phenytoin.

Heparin, widely used to prevent clots within blood vessels, can also end up changing platelet counts. That’s because the body has a reaction that causes clots and thrombocytopenia at the same time. When this happens, it is called heparin-induced thrombocytopenia, and it rarely occurs outside the hospital environment.

Bacterial infections

When bacteria proliferate too much, they can end up “poisoning” the blood, which causes the destruction of thrombocytes.

Surgeries and medical procedures

Platelets can be destroyed by passing through heart valve prostheses, vascular bypass (surgery that reconstructs the path of a blood vessel) and even machines and tubes used in blood transfusion.

Pregnancy

At the end of pregnancy, about 5% of pregnant women end up developing mild thrombocytopenia.

Diseases that cause clots

There are rare and serious diseases that cause clots and reduce the platelet count. This is because clots use many of the available platelets, whereas bone marrow does not increase production to get around the situation.

Some examples of these conditions are:

Idiopathic thrombocytopenic purpura (ITP)

Idiopathic thrombocytopenic purpura is characterized by the formation of clots in small blood vessels, including those that supply the brain, heart and kidneys. It usually happens because of damage to a gene.

Disseminated intravascular coagulation

Disseminated intravascular coagulation is usually a complication of infections and severe trauma, as well as pregnancy. It is characterized by the formation of small clots scattered throughout the body.

Spleen retains many platelets

It is normal for thrombocytes to be stored in the spleen (about ⅓ of them are), but sometimes some condition can cause it to be stored than normal. These conditions cause the spleen to increase in size, retaining many platelets and causing it to be missing from the rest of the body. Are they:

Cirrhosis

The cirrhosis is a disease that causes scarring of the liver, causing it to stop functioning properly. As the liver and spleen work together, the work of the spleen is hampered, leading to an enlarged organ.

Idiopathic myelofibrosis

Idiopathic myelofibrosis does not directly affect the spleen, but causes fibrosis in the bone marrow, making it difficult to work. This ends up causing an overload of platelets in the spleen.

Types

There are two types of thrombocytopenia, classified according to the source of the problem. Are they:

Central thrombocytopenia

The origin of central thrombocytopenia is in the bone marrow. When certain conditions alter the functioning of that part of the body, the problem is classified as central.

Cases of leukemia, aplastic anemia, dehydration and lack of some nutrients are related to this type of thrombocytopenia.

Peripheral thrombocytopenia

In peripheral thrombocytopenia, the bone marrow works well and the problem has its origin in the circulation. It is caused by the destruction of platelets as in the cases of infections, autoimmune diseases, use of medications, among others.

Groups of risk

The main risk groups for thrombocytopenia are:

  • People with cancer, aplastic anemia or autoimmune diseases;
  • Workers who come into contact with toxic substances frequently;
  • People who have reactions to certain medications;
  • Patients infected with certain types of viruses;
  • People who are born with certain genetic conditions;
  • Alcoholics;
  • Pregnant women.

Symptoms

Thrombocytopenia can often be asymptomatic , being detected by routine blood tests. However, in more severe cases, the patient may have:

  • Spontaneous bleeds that can be internal or external;
  • Appearance of bruises colored red, brown or purple;
  • Red or purple spots on the skin;
  • Bleeding that takes a long time to stop, even in small cuts;
  • Bleeding gums when brushing your teeth;
  • Spontaneous bleeding from the nose;
  • In women, there may be a very heavy menstrual flow or irregular vaginal bleeding.

Emergency signs

Internal bleeding may not be easily seen, as it does not appear on the skin. However, when bleeding is in the brain or intestine, it can be fatal. Fortunately, these bleeds generate recognizable symptoms, such as:

  • Blood in the stool, showing a reddish color or simply darkening the stool;
  • Intense headaches;
  • Weakness or paralysis on one side of the body;
  • Changes in consciousness;
  • Convulsions;
  • Fainting;
  • Sensitivity to light;
  • Difficulties to speak.

Thrombocytopenia in pregnancy

Not infrequently, pregnant women develop thrombocytopenia, especially in the last 2 months of pregnancy . It is a physiological decrease in platelet count caused by blood dilution due to fluid retention and an increase in blood plasma at this stage of pregnancy.

In these cases, the condition is usually mild and usually resolves spontaneously after delivery. However, pregnant women are not free from the diseases that can cause the problem and, therefore, it is important to investigate its origin.

Thrombocytopenia in dogs and cats

 

Did you know that pet animals can also suffer from thrombocytopenia? Yes, and the causes are very similar to that of humans: problems in the production of platelets, infectious and autoimmune diseases, cancer, among others.

The symptoms, however, can be different. The puppy may have:

  • Small red spots on the skin, usually seen when raising the animal’s fur;
  • Bleeds in the snout region;
  • Fever;
  • Lethargy;
  • Urinary bleeding.

So, if you have a pet, always be on the lookout for these signs and see a vet as soon as possible!

If your pet has recently had a blood test and, in the results, this test showed thrombocytopenia, don’t worry: there are many erroneous platelet counts, especially when they are done by automatic counters.

This is because in some animals, as in the case of cats, platelets are very similar to red blood cells, including in size. In such cases, the results can be wrong even in manual counts!

If you suspect that your pet’s test result is wrong, especially when there are no related symptoms, order a new test so that it can be ascertained that the diagnosis is correct.

How is the diagnosis of thrombocytopenia made?

As stated earlier, thrombocytopenia is most often diagnosed in routine blood tests. However, after finding the patient’s symptoms and medical history , the general practitioner may order the following tests to identify the problem:

Blood count

The blood count is an exam that assesses the quantity and quality of various blood components, such as red, white blood cells and platelets. It is widely used to diagnose nutritional disorders, autoimmune diseases and leukemia.

Blood smear

The smear is a blood test in which the sample is placed on a glass slide and is “rubbed”, spreading the blood across the surface of the slide. This allows for a microscopic analysis of the shape and size of blood cells. It usually forms a part of the CBC.

Bone marrow biopsy

The biopsy consists of removing a sample of the bone marrow, which is sent for laboratory analysis. There, the tissue is examined to check the number and types of cells present.

Alternatively, the doctor can collect and analyze the fluid that is present in the cord in order to identify damaged cells.

Ultrasound of the spleen

In order to detect the cause, the doctor may order an ultrasound of the spleen. This test uses sound waves to create images of the internal organs and tissues of the human body. In this way, he will be able to check whether the spleen is enlarged, which may be the reason for thrombocytopenia.

Is thrombocytopenia curable?

Yes, thrombocytopenia can be cured , as it is usually just a reflection of some other medical condition. When solving this problem, thrombocytopenia resolves as well. However, how long it takes for this to happen depends a lot on the cause: thrombocytopenia can last for days, months and even years.

There are cases, too, that the problem can persist for the rest of life, as in autoimmune diseases. Although drugs keep thrombocytopenia under control, it is not possible to get rid of its cause permanently, making the phenomenon happen again at any time.

Can thrombocytopenia kill?

Unfortunately , thrombocytopenia can reach the point of leading to death. This is due to severe bleeding that cannot be stopped by the lack of platelets to form a clot.

Treatment

Treatment depends on the severity of the situation. Mild thrombocytopenias may simply not need any treatment, while the more serious variables of this condition may require more invasive measures to resolve the problem.

Treating the cause

When detecting the cause of thrombocytopenia, it is important to treat it. Taking care of the lack of platelets without treating the surrounding conditions is like sweeping the dirt under the carpet, without reaching the cure for the problem.

If the shortage of thrombocytes is caused by some medication, the doctor may prescribe another to replace it.

In the case of cancer, for example, chemo or radiation therapy may be necessary, which, in turn, can impair platelet production. Therefore, other treatments may be necessary to maintain an adequate amount of thrombocytes in the bloodstream.

Immunosuppressive drugs

In case of autoimmune thrombocytopenia, the doctor may recommend medications that decrease the activity of the immune system or anti-inflammatory corticosteroids.

Blood or platelet transfusions

The most severe cases may require blood and / or platelet transfusions, especially when there is severe bleeding.

Problems related to this treatment are the destruction of platelets even before they reach the patient’s bloodstream (due to the conditions inside the tubes and catheters) and the possibility of infection by unfiltered microorganisms.

Surgery: splenectomy

In rare cases, it is necessary to remove the spleen in order to allow the platelets to continue circulating instead of being trapped in the organ.

Fortunately, in most cases, this procedure is only necessary in cases of autoimmune thrombocytopenia in adults.

Medicines for thrombocytopenia

Some drugs frequently indicated for the treatment of thrombocytopenia are:

  • Prednisone ;
  • Immunoglobulins;
  • Rituximab ;
  • Eltrombopague Olamina ;
  • Romiplostim .

Attention!

NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Complications

Intense bleeding

The human body is fragile and suffers injuries, even when everything is fine. Sometimes, a simple increase in blood pressure is enough to damage an artery or organ.

Because of the lack of platelets in the body, the formation of clots is insufficient to stop bleeding. In this way, the patient can suffer severe bleeding without even knowing it.

When the hemorrhage is external or close to the skin, it is easy to notice the problem, due to the formation of bruises or the wound that just does not stop bleeding. Internal bleeding can be discovered when it is too late.

Brain injury

Rarely, thrombocytopenia can cause bleeding in the brain. When in contact with nerve tissues, blood can damage it, causing brain damage.

Death

Both due to very severe internal bleeding and brain damage, thrombocytopenia can lead to death.

Living together

Knowing that the body can bleed easily and that this is not easy to stop, there are some precautions that the patient must take until the problem is resolved. Some tips are:

Avoid situations that pose a risk of bleeding

Due to the difficulty in stopping bleeding, it is recommended to avoid

  • Intense efforts;
  • Contact sports such as football, rugby, basketball, etc .;
  • Alcohol consumption, both due to the change that the substance causes in the production of platelets and the possibility of accidents;
  • Medicines that alter the function of platelets (anticoagulants, anti-inflammatories, Aspirin, ginkgo biloba).

food

Maintain a balanced diet that helps in the production of blood cells, rich in:

  • Cereals;
  • Fruits;
  • Vegetables;
  • Vegetables;
  • Lean meats.

Beware of infections

If the spleen is removed, the patient may be more susceptible to certain infections. That is why:

  • Always wash your hands with soap and water;
  • Avoid contact with possibly contaminated surfaces. If this is not possible, always have an antiseptic product to clean your hands frequently;
  • Clean the wounds thoroughly and change the dressings frequently to prevent bacteria from entering.

Prognosis

Thrombocytopenia can have a very favorable prognosis when it is possible to detect its cause, treat it and keep it under control. However, there are serious cases that can lead to death.

Prevention

Normally, it is not possible to prevent thrombocytopenia, as it may be the result of autoimmune problems, cancer or other diseases that may be out of control. However, there are some measures to avoid risk factors that can trigger the problem, such as:

  • Avoid alcohol consumption, as this substance slows down the production of platelets;
  • Avoid contact with toxic substances;
  • Avoid medications that you know have caused you thrombocytopenia before;
  • Take care with medications that have an effect on the bloodstream, especially platelets. Medications like Aspirin and ibuprofen can end up thinning the blood, preventing clots when they are needed;
  • Always be vaccinated against viruses that can affect platelets. If you have children, talk to their pediatrician to keep your vaccines up to date.

Although little talked about, thrombocytopenia has dangerous consequences when it is not treated. Share this text so that more people are aware of the condition.

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