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 bleeding). 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 platelets. -- 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 material. -- 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.

1. Fitango Education
Health Topics
Thrombocytopenia
http://www.fitango.com/categories.php?id=360

2. Overview
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
1

3. Overview
bleeding).
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
2

4. Overview
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
3

5. Overview
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
platelets.
4

6. Overview
-- 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
5

7. Overview
platelets. It also helps your body fight infection and
remove unwanted cell
material.
-- A combination of the above factors.
-- How long thrombocytopenia lasts depends on
6

8. Overview
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,
7

9. Overview
you may need medicines or blood or
platelet transfusions. Rarely, the spleen may need
to be removed.
8

10. Causes
Many factors can cause thrombocytopenia (a
low platelet count). The condition can be inherited
or acquired.
"Inherited" means your parents pass the gene for
the condition to
9

11. Causes
you. "Acquired" means you aren't born with the
condition, but you
develop it. Sometimes the cause of
thrombocytopenia isn't known.
In general, a low platelet count occurs
because:
10

12. Causes
-- The body's bone marrow doesn't make enough
platelets.
-- The bone marrow makes enough platelets, but
the body destroys them or uses them up.
-- The spleen holds on to too many platelets.
11

13. Causes
-- A combination of the above factors also may
cause a low platelet count.
12

14. Causes
**The Bone Marrow Doesn't Make Enough
Platelets**
Bone marrow is the sponge-like tissue
inside the bones. It contains stem cells that
develop into red blood cells,
13

15. Causes
**The Bone Marrow Doesn't Make Enough
white blood cells, and platelets. When stem cells
are damaged, they don't grow
into healthy blood cells.
Many conditions and factors can damage stem
cells.
14

16. Causes
**Cancer**
Cancer, such as leukemia (lu-KE-me-ah) or
lymphoma (lim-FO-ma), can damage the bone
marrow and destroy blood stem cells.
Cancer treatments, such as radiation and
chemotherapy, also destroy the stem
15

17. Causes
**Cancer**
cells.
**Aplastic Anemia**
Aplastic
anemia is a rare, serious blood disorder in which
the bone marrow
stops making enough new blood cells. This lowers
the number of platelets in
16

18. Causes
**Cancer**
your blood.
**Toxic Chemicals**
Exposure to toxic chemicals—such as
pesticides, arsenic, and benzene—can slow the
production of platelets.
17

19. Causes
**Medicines**
Some medicines, such as diuretics and
chloramphenicol, can slow the production of
platelets. Chloramphenicol (an
antibiotic) rarely is used in the United States.
18

20. Causes
**Medicines**
Common over-the-counter medicines, such as
aspirin or ibuprofen, also can affect platelets.
19

21. Causes
**Alcohol**
Alcohol also slows the production of
platelets. A temporary drop in the platelet count is
common among heavy
drinkers, especially if they're eating foods that are
low in iron, vitamin B12,
20

22. Causes
**Alcohol**
or folate.
**Viruses**
Chickenpox, mumps, rubella, Epstein-Barr
virus, or parvovirus can decrease your platelet
count for a while. People who
have AIDS often develop thrombocytopenia.
21

23. Causes
**Genetic Conditions**
Some genetic conditions can cause low
numbers of platelets in the blood. Examples
include Wiskott-Aldrich and
May-Hegglin syndromes.
22

24. Causes
**The Body Destroys Its Own Platelets**
A low platelet count can occur even if the
bone marrow makes enough platelets. The body
may destroy its own platelets due
to autoimmune diseases, certain medicines,
infections, surgery, pregnancy, and
23

25. Causes
**The Body Destroys Its Own Platelets**
some conditions that cause too much blood
clotting.
**Autoimmune Diseases**
Autoimmune diseases occur if the body's
immune system mistakenly attacks healthy cells in
the body. If an autoimmune
24

26. Causes
**The Body Destroys Its Own Platelets**
disease destroys the body's platelets,
thrombocytopenia can occur.
One example of this type of autoimmune
disease is immune
thrombocytopenia(ITP). ITP is a bleeding disorder
in which the blood
25

27. Causes
**The Body Destroys Its Own Platelets**
doesn't clot as it should. An autoimmune response
is thought to cause most
cases of ITP.
Normally, your immune system helps your
body fight off infections and diseases. But if you
have ITP, your immune system
26

28. Causes
**The Body Destroys Its Own Platelets**
attacks and destroys its own platelets. Why this
happens isn't known. (ITP also
may occur if the immune system attacks your bone
marrow, which makes
platelets.)
Other autoimmune diseases that destroy
27

29. Causes
**The Body Destroys Its Own Platelets**
platelets include lupus and rheumatoid arthritis.
**Medicines**
A reaction to medicine can confuse your
body and cause it to destroy its platelets. Examples
of medicines that may
28

30. Causes
**The Body Destroys Its Own Platelets**
cause this to happen include quinine; antibiotics
that contain sulfa; and some
medicines for seizures, such as
Dilantin,®vancomycin, and rifampin. (Quinine is
a substance often found in tonic water and
nutritional health products.)
Heparin is a medicine commonly used to
29

31. Causes
**The Body Destroys Its Own Platelets**
prevent blood clots. But an immune reaction may
trigger the medicine to cause
blood clots and thrombocytopenia. This condition
is called heparin-induced
thrombocytopenia (HIT). HIT rarely occurs outside
of a hospital.
In HIT, the body's immune system attacks a
30

32. Causes
**The Body Destroys Its Own Platelets**
substance formed by heparin and a protein on the
surface of the platelets. This
attack activates the platelets and they start to form
blood clots.
Blood clots can form deep in the legs (deep vein
thrombosis), or they can break loose and travel to
the lungs (pulmonary
31

33. Causes
**The Body Destroys Its Own Platelets**
embolism).
**Infection**
A low platelet count can occur after blood
poisoning from a widespread bacterial infection. A
virus, such as mononucleosis
or cytomegalovirus, also can cause a low platelet
count.
32

34. Causes
**Surgery**
Platelets can be destroyed when they pass
through man-made heart valves, blood vessel
grafts, or machines and tubing used
for blood
transfusions or bypass
33

35. Causes
**Surgery**
surgery.
**Pregnancy**
About 5 percent of pregnant women develop
mild thrombocytopenia when they're close to
delivery. The exact cause isn't
known for sure.
34

36. Causes
**Surgery**
Rare and Serious Conditions That Cause
Blood Clots
Some rare and serious conditions can cause
a low platelet count. Two examples are thrombotic
thrombocytopenic purpura (TTP) and disseminated
35

37. Causes
**Surgery**
intravascular coagulation (DIC).
TTP is a rare blood condition. It causes
blood clots to form in the body's small blood
vessels, including vessels in the
brains, kidneys, and heart.
36

38. Causes
**Surgery**
DIC is a rare complication of pregnancy,
severe infections, or severe trauma. Tiny blood
clots form suddenly throughout
the body.
In both conditions, the blood clots use up
many of the blood's platelets.
37

39. Causes
**The Spleen Holds On to Too Many Platelets**
Usually, one-third of the body's platelets
are held in the spleen. If the spleen is enlarged, it
will hold on to too many
platelets. This means that not enough platelets will
circulate in the blood.
38

40. Causes
**The Spleen Holds On to Too Many Platelets**
An enlarged spleen often is due to cancer
or severe liver disease, such as cirrhosis (sir-RO-
sis). Cirrhosis is a disease
in which the liver is scarred. This prevents it from
working well.
An enlarged spleen also might be due to a
39

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 isn't able to make
blood cells.
National Heart Lung and Blood Insitute
40

42. Risks
People who are at highest risk for
thrombocytopenia are those affected by one of the
conditions or factors
discussed in "What
Causes Thrombocytopenia?" This includes people
who:
41

43. Risks
-- Have certain types of cancer, aplastic
anemia, or autoimmune diseases
-- Are exposed to certain toxic chemicals
-- Have a reaction to certain medicines
-- Have certain viruses
42

44. Risks
-- Have certain genetic conditions
People at highest risk also include heavy
alcohol drinkers and pregnant women.
National Heart Lung and Blood Institute
43

45. Symptoms
Mild to serious bleeding causes the main
signs and symptoms of thrombocytopenia.
Bleeding can occur inside your body
(internal bleeding) or underneath your skin or
from the surface of your skin
44

46. Symptoms
(external bleeding).
Signs and symptoms can appear suddenly or
over time. Mild thrombocytopenia often has no
signs or symptoms. Many times,
it's found during a routine blood test.
45

47. Symptoms
Check with your doctor if you have any
signs of bleeding. Severe thrombocytopenia can
cause bleeding in almost any
part of the body. Bleeding can lead to a medical
emergency and should be
treated right away.
46

48. Symptoms
External bleeding usually is the first sign
of a low platelet count. External bleeding may
cause purpura (PURR-purr-ah) or
petechiae (peh-TEE-key-ay). Purpura are purple,
brown, and red bruises. This
47

49. Symptoms
bruising may happen easily and often. Petechiae
are small red or purple dots on
your skin.
Other signs of external bleeding include:
-- Prolonged bleeding, even from minor cuts
48

50. Symptoms
-- Bleeding or oozing from the mouth or nose,
especially nosebleeds or bleeding from brushing
your teeth
-- Abnormal vaginal bleeding (especially heavy
menstrual flow)
49

51. Symptoms
A lot of bleeding after surgery or dental
work also might suggest a bleeding problem.
Heavy bleeding into the intestines or the
brain (internal bleeding) is serious and can be fatal.
Signs and symptoms
50

52. Symptoms
include:
-- Blood in the urine or stool or bleeding
from the rectum. Blood in the stool can appear as
red blood or as a dark, tarry
color. (Taking iron supplements also can cause
dark, tarry stools.)
51

53. Symptoms
-- Headaches and other neurological symptoms.
These problems are very rare, but you should
discuss them with your doctor.
http://www.nhlbi.nih.gov/health/health-
topics/topics/thcp/signs.html
52

54. Diagnosis
Your doctor will diagnose thrombocytopenia
based on your medical history, a physical
exam, and test results. A
hematologist also may be involved in your care.
This is a doctor who
53

55. Diagnosis
specializes in diagnosing and treating blood
diseases and conditions.
Once thrombocytopenia is diagnosed, your
doctor will begin looking for its cause.
54

56. Diagnosis
**Medical History**
Your doctor may ask about factors that can
affect your platelets, such as:
-- The medicines you take, including
55

57. Diagnosis
**Medical History**
over-the-counter medicines and herbal remedies,
and whether you drink beverages
that contain quinine. Quinine is a substance often
found in tonic water and
nutritional health products.
-- Your general eating habits, including the
56

58. Diagnosis
**Medical History**
amount of alcohol you normally drink.
-- Your risk for AIDS, including questions
about blood
transfusions, sexual partners, intravenous (IV)
drugs, and exposure to
57

59. Diagnosis
**Medical History**
infectious blood or bodily fluids at work.
-- Any family history of low platelet counts.
58

60. Diagnosis
**Physical Exam**
Your doctor will do a physical exam to look
for signs and symptoms of bleeding, such as
bruises or spots on the skin. He or
she will check your abdomen for signs of an
enlarged spleen or liver. You also
59

61. Diagnosis
**Physical Exam**
will be checked for signs of infection, such as a
fever.
**Diagnostic Tests**
Your doctor may recommend one or more of
the following tests to help diagnose a low platelet
count. For more information
60

62. Diagnosis
**Physical Exam**
about blood tests, go to the Health Topics Blood
Tests article.
**Complete Blood Count**
A complete blood count (CBC) measures the
levels of red blood cells, white blood cells, and
platelets in your blood. For
61

63. Diagnosis
**Physical Exam**
this test, a small amount of blood is drawn from a
blood vessel, usually in
your arm.
If you have thrombocytopenia, the results
of this test will show that your platelet count is
low.
62

64. Diagnosis
**Blood Smear**
A blood smear is used to check the
appearance of your platelets under a microscope.
For this test, a small amount
of blood is drawn from a blood vessel, usually in
your arm.
63

65. Diagnosis
**Bone Marrow Tests**
Bone marrow
tests check whether your bone marrow is healthy.
Blood cells,
including platelets, are made in your bone marrow.
The two bone marrow tests
64

66. Diagnosis
**Bone Marrow Tests**
are aspiration (as-pih-RA-shun) and biopsy.
Bone marrow aspiration might be done to
find out why your bone marrow isn't making
enough blood cells. For this test,
your doctor removes a sample of fluid bone
marrow through a needle. He or she
65

67. Diagnosis
**Bone Marrow Tests**
examines the sample under a microscope to check
for faulty cells.
A bone marrow biopsy often is done right
after an aspiration. For this test, your doctor
removes a sample of bone marrow
tissue through a needle. He or she examines the
tissue to check the number and
66

68. Diagnosis
**Bone Marrow Tests**
types of cells in the bone marrow.
**Other Tests**
If a bleeding problem is suspected, you may
need other blood tests as well. For example, your
doctor may recommend PT and
67

69. Diagnosis
**Bone Marrow Tests**
PTT tests to see whether your blood is clotting
properly.
Your doctor also may suggest an ultrasound
to check your spleen. An ultrasound uses sound
waves to create pictures of your
spleen. This will allow your doctor to see whether
your spleen is enlarged.
68

70. Diagnosis
**Bone Marrow Tests**
National Heart Lung and Blood Institute
69

71. Treatment
Treatment for thrombocytopenia depends on
its cause and severity. The main goal of treatment
is to prevent death and
disability caused by bleeding.
If your condition is mild, you may not need
70

72. Treatment
treatment. A fully normal platelet count isn't
necessary to prevent bleeding,
even with severe cuts or accidents.
Thrombocytopenia often improves when its
underlying cause is treated. People who inherit the
condition usually don't
71

73. Treatment
need treatment.
If a reaction to a medicine is causing a
low platelet count, your doctor may prescribe
another medicine. Most people
recover after the initial medicine has been
stopped. For heparin-induced
72

74. Treatment
thrombocytopenia (HIT), stopping the heparin isn't
enough. Often, you'll need
another medicine to prevent blood clotting.
If your immune system is causing a low
platelet count, your doctor may prescribe
medicines to suppress the immune
73

75. Treatment
system.
**Severe Thrombocytopenia**
If your thrombocytopenia is severe, your
doctor may prescribe treatments such as
medicines, blood or platelet
transfusions, or splenectomy.
74

76. Treatment
**Medicines**
Your doctor may prescribe corticosteroids,
also called steroids for short. Steroids may slow
platelet destruction. These
medicines can be given through a vein or by
mouth. One example of this type of
75

77. Treatment
**Medicines**
medicine is prednisone.
The steroids used to treat thrombocytopenia
are different from illegal steroids taken by some
athletes to enhance
performance.
Your doctor may prescribe immunoglobulins
76

78. Treatment
**Medicines**
or medicines like rituximab to block your immune
system. These medicines are
given through a vein. He or she also may prescribe
other medicines, such as
eltrombopag or romiplostim, to help your body
make more platelets. The former
77

79. Treatment
**Medicines**
comes as a tablet to take by mouth and the latter
is given as an injection
under the skin.
78

80. Treatment
**Blood or Platelet Transfusions**
Blood or platelet transfusions are used to
treat people who have active bleeding or are at a
high risk of bleeding. During
this procedure, a needle is used to insert an
intravenous (IV) line into one of
79

81. Treatment
**Blood or Platelet Transfusions**
your blood vessels. Through this line, you receive
healthy blood or platelets.
For more information about this procedure,
go to the Health Topics Blood
Transfusion article.
80

82. Treatment
**Splenectomy**
A splenectomy is surgery to remove the
spleen. This surgery may be used if treatment with
medicines doesn't work. This
surgery mostly is used for adults who
have immune
81

83. Treatment
**Splenectomy**
thrombocytopenia (ITP). However, medicines often
are the first course
of treatment.
82

84. Prevention
Whether you can prevent thrombocytopenia
depends on its specific cause. Usually the
condition can't be prevented.
However, you can take steps to prevent health
problems associated with
83

85. Prevention
thrombocytopenia. For example:
-- Avoid heavy drinking. Alcohol slows the
production of platelets.
-- Try to avoid contact with toxic chemicals.
84

86. Prevention
Chemicals such as pesticides, arsenic, and benzene
can slow the production of
platelets.
-- Avoid medicines that you know have
decreased your platelet count in the past.
85

87. Prevention
-- Be aware of medicines that may affect your
platelets and raise your risk of bleeding. Two
examples of such medicines are
aspirin and ibuprofen. These medicines may thin
your blood too much.
-- Talk with your doctor about getting
86

88. Prevention
vaccinated for viruses that can affect your
platelets. You may need vaccines
for mumps, measles, rubella, and chickenpox. You
may want to have your child
vaccinated for these viruses as well. Talk with your
child's doctor about these
vaccines.
87