Platelets are the smallest of the three major blood cells and it has the function as a primary component for blood coagulation. It helps stop bleeding by clumping at the site of blood vessel injury.
What is platelet count?
It is the quantity of platelets that circulate in the blood stream for every microliter of blood. Laboratory values and platelet count units of measurement is per cubic millimeter (a mm3 equals a microliter).
Platelet count can either be derived manually using a hemocytometer (manual platelet counting) or an automated platelet analyzer that uses electrical impedance (automated platelets counting).
Average Platelet Levels
The blood component is degraded in the liver and spleen. The spleen serves as a place of isolation for blood cells. Normally, the spleen approximately stores about 1/3 of platelets while the remaining 2/3 is circulated in the blood.
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Platelets can be evaluated by taking a sample of venous or capillary blood.
A capillary blood route is performed when the use of venous route is not recommended, or when the route is difficult due to superficial veins or veins that are sensitive.
Blood samples may also be taken from the fingertip, earlobe, or toe in newborns.
Factors That Influence Platelet Count
It is medically useful in many ways to have a clear understanding on what is a platelet count, especially when abnormal changes in platelet characteristics is observed.
Decreased blood platelet count is called thrombocytopenia. According to gradation, it can vary from moderate, moderately severe, and severe. The lower the platelet count, the higher the severity of the condition.
A lower platelet count brings the risk of spontaneous bleeding in the skin and mucous membranes (nose, gastrointestinal, and genitourinary tract). The most dangerous location for bleeding are areas in the central nervous system and the eye.
A low platelet count may be temporary in some cases that it lasts for just a number of days, but may also be chronic, depending on the cause.
The condition usually improves when the disorder is established and treatment is provided to the specific disease or disorder that underlies being the root cause of thrombocytopenia.
The underlying medical condition may need treatment with drugs, surgery, or blood transfusions.
I. Decrease in Platelets
A decrease in platelets can be innate or acquired (more often). Acquired forms are caused by factors that have affected the bone marrow. These factors may include the following:
- Anemia – due to lack of folic acid (vitamin B9) or vitamin B12 resulting to a reduction in the production of blood cells.
- Alcohol – thrombocytopenia is often observed in heavy drinkers, especially in individuals with poor diet practices.
- Viral infection
- Toxic chemicals
- Ionizing radiation
- Tumor metastasis
- Intake of certain medications
Increased platelet degradation and consumption
In some cases of thrombocytopenia, platelets are decreased because of destruction or increased in their consumption. The normal production rate of the bone marrow cannot make up for the loss, which is why a fall in the number of platelets develop. This abnormal condition can be divided into immune and non-immune forms.
In non-immune thrombocytopenia, this group of abnormal condition includes hemolytic uremic syndrome (HUS), thrombotic thrombocytopenic purpura (TTP), and thrombocytopenia caused by disseminated intravascular coagulopathy.
HUS is characterized by the triad of acute renal failure, hemolytic anemia, and thrombocytopenia. The medical condition may display acute febrile symptoms with diarrhea, or upper respiratory tract infection. In children, this rare disorder is characteristic to early childhood (younger than 4 years old). The most common factor that can lead to the development of HUS is an infection with E.coli serotype O157: H7, although other bacterial and viral pathogens may also lead to the syndrome.
TTP is a disease characterized by a pentad of symptoms: thrombocytopenia, hemolytic anemia, renal failure, fever, and neurologic disorders. The disease is due to a reduction in the formation of enzyme ADAMTS13 which is important in the biology of von Willebrand factor, significant in coagulation. There will be increased production of blood clots in small blood vessels. The damage is usually caused by the formation of auto-antibodies against the enzyme which may be acute but a life-threatening condition.
Some other reasons for increased platelet degradation
- Certain drugs, alcohol, bacteria, viruses that directly decompose platelets.
- Immune system abnormal functioning, mistakenly identifying normal cells, forming antibodies to destroy them. The creation of antibodies may occur after transfusion of blood components or platelets. Destruction is also possible due to autoimmune diseases or intake of certain medications.
- Attributing to the abnormal formation of numerous blood clots in the circulation, there can be increased platelet consumption. This may happen due to severe bacterial or viral infection, a serious complication of pregnancy, drugs, or tissue damage.
- During pregnancy, platelet count may be slightly reduced.
The “capture” of platelets in the spleen
The spleen plays an important role in the body’s defense against infection. However, this place of storage for the blood cells can be impaired for a number of reasons. The damage can result to large amounts of platelet accumulation in the spleen.
Normally, stored platelets in the spleen amount to only a third of all platelets in the body. But with an enlarged spleen, it can reach up to 90% of all platelets, which causes a relative decrease in the number of platelets circulating in the bloodstream. The life span of platelets remains normal still.
Thrombocytopenia due to splenomegaly doesn’t come with an increased risk of bleeding. But often, hypersplenism associated with liver cirrhosis, which is associated with disorders on normal coagulation, predisposes the patient to be at increased risk of bleeding.
II. Elevated Platelet Count:
The coexistence of multiple causes
Elevated platelet count can occur as a result of a disorder in the bone marrow, causing it to release large number of platelets in the circulating blood. It may also occur secondarily, as a result of the body’s response to infection in many diseases.
If the disorder happens at the level of the bone marrow, it may lead to extremely large number of platelets, increasing the risk of developing thrombosis, which can be life threatening.
Treatment may focus on the root cause of the underlying condition. Sometimes, increase in platelet counts is temporary, but can also be long-term. Each type may require specific therapy.
It is due to increased production of platelets as a response to certain diseases. In reactive thrombocytosis, the platelets still have the capacity to function normally. Reactive thrombocytosis can occur due to:
- Infection and inflammation
- Inflammatory diseases (rheumatoid arthritis, celiac disease, connective tissue disease, inflammatory bowel disease, and others.)
- Post menorrhagia
- Removal of the spleen
- Allergic reactions
- Kidney diseases
- Anemia due to iron deficiency
- Hemolytic anemia – anemia due to the decomposition of red blood cells
- Use of certain drugs, such as epinephrine, tretinoin, vincristine
- After exercise, in response to increased physical activity
Primary thrombocythemia is a rare blood clotting disorder where underlying bone marrow impairment results to an abnormal production of extremely large number of platelets. The exact cause of the disease is unknown.
Furthermore, in primary thrombocytopenia, platelets have a disturbed function. Due to the increased number of the blood component, there will be an increased tendency for thrombosis. When the increase is severe, it can also result to a tendency of developing bleeding disorders.
The most common causative factors identified among several patients who have developed changes in platelet count are existing disease/s, drugs, and alcohol consumption.
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