10 Causes of Low Platelets

10 Causes of Low Platelets
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Platelets or thrombocyte cell fragments are characterized as small oval, spherical blood component with no nucleus, formed in the bone marrow and play a role in blood coagulation.

The normal quantity of platelets in the blood is about 150-450×109 / L of blood. The lifetime of platelets is 7-10 days. The blood component is degraded in the liver and spleen.

The spleen is a designated place of isolation in the body where the storage of blood cells is made, including platelets. Normally, the spleen sequesters approximately 1/3 of newly produced 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 (presented below is the risk of bleeding in patients with thrombocytopenia). 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.

Low platelets causes a risk of bleeding in varied degrees in relation to the amount of drop which is mainly influenced by the causative factor involved. Let us take a look at each different 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. The condition may lead to a disorder described as 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 adults may also develop acute ITP, the disease occurs more often in gradual form (chronic ITP). Most adults do not remember whether it had been a 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.

causes of low platelets itp

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, disseminated intravascular coagulation (DIC), HIV, Thrombotic thrombocytopenic purpura (TTP), and Hemolytic-uremic syndrome (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

  • mild thrombocytopenia
  • asymptomatic thrombocytopenia
  • positive record of previous thrombocytopenia
  • development of thrombocytopenia during pregnancy
  • absence of fetal thrombocytopenia
  • thrombocytopenia retires after birth

3. Infection

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 instead resulted from inefficient production of platelets.

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.

causes of low platelets infection

4. Malignant disease

Lymphoproliferative diseases such as chronic lymphatic leukemia and lymphoma may also be associated with immune-mediated thrombocytopenia, one of the common malignant disease-related 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 the 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 transfusion is made and platelet count falls.

causes of low platelets dilutional

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 causing the need to undergo certain processes before being able to circulate platelets. Thrombocytopenia typically occurs about 7-10 days after radiotherapy.

7. Drug-induced thrombocytopenia

Most of the medicament-related cases of thrombocytopenia is a result of any recently introduced drug during therapy. In fact, the time it takes for low platelet count to occur is only 2 weeks. Nevertheless, there have been described cases where the patient has already been taking medications for three years before a drop in platelet count occurred.

The diagnosis for drug-induced thrombocytopenia can be settled when the cease of use of the suspected drug resulted to platelet count returning to normal levels. 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 a rechallenge with the drug. If the medicament is the culprit, re-provocation will lead to thrombocytopenia within three days of application.

causes of low platelets drug induced

8. Alcohol

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. It is because HIT patients are exposed to increased risk of thrombosis. Thrombocytopenia due to heparin can develop 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. In fact, heparin-induced thrombocytopenia has been observed with the administration of heparin in low doses just for the purpose of flushing the vascular catheter. 

It is believed however that low molecular weight heparin is less immunogenic and involved in only a few number of cases of thrombocytopenia compared to standard heparin. Remember, low platelets cause a risk of bleeding, especially if it will be a large drop.

Nonetheless, immune-mediated thrombocytopenia is still described in the use of low molecular weight heparin. Since the two types of heparin display a very pronounced cross-reactivity between them, it is often not possible, that even in the event of thrombocytopenia, to simply replace the use of standard heparin with that of low molecular weight.

In everyday clinical practice, withdrawal of thrombocytopenia following the lifting of heparin use confirms the diagnosis.

causes of low platelets heparin induced

10. Hypersplenism

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 only be 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).

ITP in children

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Updated: October 1, 2018

About the Author:

Melissa Gomez, RN, MSN is a board certified nurse and has been a contributing writer for the past five years. Ms. Gomez has a special focus on platelet-related illness prevention and health promotion.

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