10 Causes of Low Platelets
Platelets or thrombocyte cells is described as small oval or spherical cells with no nucleus. They are created in the bone marrow and play a role in blood coagulation.
The spleen is a place of isolation for blood cells which includes the platelets. Normally, the spleen allocates approximately 1/3 of platelets.
It will be a really horrible situation to experience sudden and uncontrolled gushing out of blood from the nose, gums and other openings of the body. And sadly, it could happen with a really low platelet count. Before that happens, better manage it immediately. This may usually be a costly endeavor but there are affordable options such as all-natural remedies you can learn from money back guaranteed materials like Conquer Low Platelets.
What causes low platelets? Decreased platelet count is called thrombocytopenia. According to gradiation, it can vary from moderate, moderately severe, and severe. With a lower cell count, the severity of the disease becomes bigger (presented below is the risk of bleeding in patients with thrombocytopenia). Low platelets causes varied degrees of drop amounts which is mainly influenced by the causative factor involved. Let us take a look at the potential degree of bleeding that can take place depending on the platelet level as detailed below:
|Platelet count||Risk of bleeding|
|>100.000/µL||No abnormal bleeding, even after surgery|
|50.000–100.000/µL||The patient may bleed more than normal after serious injury|
|20.000–50.000/µL||Hemorrhage comes at a smaller injury|
|<20.000/µL||The patient may bleed spontaneously|
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Some of the major causes of low platelets or thrombocytopenia:
1. Immune-mediated Thrombocytopenic Purpura
The immune-mediated thrombocytopenic purpura, also known as ITP is a condition marked by the development of antibodies against platelets. This attack of antibodies to normal cells is what causes low platelet count levels in patients with ITP. It then leads to immune-mediated thrombocytopenia.
Description of the two forms of ITP: acute and chronic.
The acute form is more common in children, and usually occurs after recovery from an infection. Frequently the patient has a non-specific viral infection. Although, there are times where acute ITP develops when recovering from a bacterial infection. While the adults may develop acute ITP, the disease occurs more often gradually (chronic ITP). Most adults do not remember whether it had been viral or bacterial infection. Approximately 90% of ITP patients is younger than 40 years old. Interestingly, the chronic form of ITP affects women more frequently. Read ITP Treatment Methods.
2. Thrombocytopenia in pregnancy
Almost 5% of women develop thrombocytopenia during pregnancy. It is a cause of low platelets referred to as gestational thrombocytopenia, which should be distinguished not only from ITP, but also from other causes of thrombocytopenia associated with pregnancy, such as eclampsia, the medical thrombocytopenia, disseminated intravascular coagulation (DIC), HIV and TTP / HUS.
Clinical findings in favor of gestational thrombocytopenia, and against ITP will present a platelet count > 50,000 / uL and a history of thrombocytopenia during pregnancy. If the platelet count falls to <50,000 / uL, the patient should seriously consider the possibility of ITP. The diagnostic criteria for gestational thrombocytopenia are listed in the following table.
Diagnostic criteria for gestational thrombocytopenia
Infection is one of many low platelet count causes that has been commonly identified in patients. The main cause of thrombocytopenia by infection is viral in type. Among many other examples include infectious mononucleosis, CMV and HIV. In most of the cases, the patient’s medical history may reveal recent symptoms consistent with viral infection.
Thrombocytopenia can be present in patients with HIV where it may be immune mediated or non-immunological in origin, but it seems that the majority of the cases have shown that the drop in platelet count has resulted from inefficient production of platelets instead.
It is not uncommon that the cause of the drop will depend on several factors. In addition to immune-mediated thrombocytopenia, thrombocytopenia in patients with HIV can also happen due to suppression brought about by bone marrow granulomatous disease or probably induced by drugs. Moreover, the HIV immune mediated thrombocytopenia may occur at any time during HIV infection. It can even occur when the viral load is small, and the number of CD4 lymphocytes is relatively well preserved.
Thrombocytopenia, other than with its relation to a viral condition, can occur with infections that are caused by bacteria (gram-positive and negative), mycoplasma, rickettsia, as well as syphilis and malaria.
4. Malignant disease
Lymphoproliferative diseases such as chronic lymphatic leukemia and lymphoma may also be associated with immune-mediated thrombocytopenia, one of the common diseases related to low platelet causes.
However, more often the result of thrombocytopenia is due to a decrease in platelet infiltration of the bone marrow or probably because of cancer treatment with cytostatics.
Although immune-mediated thrombocytopenia is also described in patients with solid tumors, but this association is rare.
5. Dilutional thrombocytopenia
This is a common cause of thrombocytopenia in hospitalized patients who have lost a significant amount of blood. This happens when the aggressive application of intravenous fluids platelet count falls.
6. Radiation Specific
Radiotherapy can complicate the development of thrombocytopenia. It is one of the causes of low platelet count where damage occurs in the bone marrow affecting megakaryocytes that has to undergo a certain process before platelets get circulated. Thrombocytopenia typically occurs about 7-10 days after radiotherapy.
7. Drug induced thrombocytopenia
Most of the medicament cases of thrombocytopenia is a result of any recently introduced drugs during therapy. In fact, the time required for the occurrence of low platelet count is only 2 weeks. Nevertheless, there are described cases in which the patient has been taking medications for three years before it occurred.
The diagnosis of drug-induced or medical thrombocytopenia is set when the abolition of the suspected drug and the platelet count returns to normal. In most cases, thrombocytopenia draws 5-7 days after discontinuation of the drug. Sometimes thrombocytopenia lasts longer due to the slow elimination of the drug or its metabolites out of the body.
Although thrombocytopenia, after rechallenge can represent an even stronger diagnostic evidence, clinicians should always be in alert because re-provocation can be dangerous. Some patients react to display severe thrombocytopenia after rechallenge with the drug. If the medicament is the culprit, re-provocation will lead to thrombocytopenia within three days of application.
Thrombocytopenia can also be common in serious alcoholics. This is a lifestyle related cause of low platelets.
What causes platelets to be low when drinking alcohol? Although reduced platelet counts may be due to bone marrow suppression induced by alcohol, in this population group are two significant factors: lack of folate and hypersplenism because of chronic liver disease.
Thrombocytopenia in alcoholics can be generally mild to moderate, but we can find cases of severe thrombocytopenia, particularly when there are several factors involved (eg. Folate deficiency + bone marrow suppression induced by alcohol).
9. Heparin-induced thrombocytopenia
For every patient with a low platelet count, it is important to consider heparin-induced thrombocytopenia. This is because these patients are exposed to increased risk of thrombosis. Thrombocytopenia due to heparin can be developed in 1% to 5% of patients. In most cases, this is what causes low blood platelets in just 6-10 days after the start of treatment with heparin.
However, if the patient has already received treatment with heparin in the past, thrombocytopenia may develop faster. It is important to understand that even low doses of heparin can cause thrombocytopenia. Remember, low platelets cause the risk of bleeding, especially if it will be a large drop.
In fact, heparin-induced thrombocytopenia has also been observed after the administration of heparin in low doses for the purpose of just flushing the vascular catheter. It is believed however that the low molecular weight heparin is less immunogenic and is involved with only a few number of cases on thrombocytopenia compared to standard.
Nonetheless, immune-mediated thrombocytopenia is still described in the use of low molecular weight heparin. Since between these two types of heparin displays a very pronounced cross-reactivity, it is often not possible, that even in the event of thrombocytopenia, simply replace the use of standard heparin to that of low molecular weight.
In everyday clinical practice, withdrawal of thrombocytopenia following the lifting of heparin use confirms the diagnosis.
Hypersplenism is a fairly common cause of thrombocytopenia due to increased retention of platelets. In patients with hypersplenism, platelet count rarely falls to <30,000 / uL. A platelet count less than this should constrain the search for additional or other etiology.
Although, it may also be usually present in leukopenia and / or anemia, in some situations, it may be only displayed in cases of thrombocytopenia.
Detection of splenomegaly during physical examination is considered to support the diagnosis. However, studies have shown that physical examination does not always detect many cases of splenomegaly. Therefore, it may be necessary to perform estimations on the size of the spleen using imaging (eg. Ultrasound examination).
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