Thrombocytopenia, also known as thrombopenia is a blood disorder where there is a relative reduction in the number of platelets (thrombocytes) present in the blood circulatory system. It is a display of lowered amount of platelets in the blood.
Platelets have an important role in blood clotting. They are formed in the bone marrow just like the other cells found in the blood. Megakaryocytes are the precursors where platelets originate from; these are large cells found in the bone marrow. The fragments of megakaryocytes become the platelets that is released to the blood.
The circulating platelets in the bloodstream make up 2/3 of the total platelets released from the body’s bone marrow. Those that are stored in the spleen constitutes the remaining ones. Platelets have a lifespan of 7 to 10 days in the blood, after which they are eliminated from blood circulation.
The number of platelets in the blood tissue is termed as the ‘platelet count’ and normally ranges from 150,000 to 450,000 per one millionth of a litre of blood. Furthermore, a platelet count of less than 150,000 is referred to as thrombocytopenia while an amount greater than 450,000 is termed as thrombocytosis.
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Injury to a blood vessel results in the production of chemicals that help in the activation of platelets. When activated, platelets become sticky and start adhering to one another as well as to the blood vessel wall at the surface of the injured vessel, in order to slow down and consequently, stop the bleeding. This is achieved by plugging up the damaged blood vessels or tissues through a process called hemostasis.
A very low platelet count can result to spontaneous bleeding as an effect of the delay in the normal process of clotting. On the other hand, mild thrombocytopenia may not display harmful effects on the clotting pathways.
Thrombocytopenia Causes in Adults
Thrombocytopenia or low platelet count can be a result of a variety of reasons. The factors causing the blood disorder can be generally divided into three classes. Thrombocytopenia may be due to increase in the destruction or consumption of platelets, increased splenic sequestration (that is, capturing of circulating platelets in the spleen), or decrease in platelet production.
An increase in the number of platelets destroyed or consumed can be seen in a number of medical conditions. These disorders may either be immune related or non-immune related factors. There are also drug-related factors that result to low platelet count by triggering reactions on immune functions to go against normal blood platelets. This is called drug-induced thrombocytopenia.
Decreased production of platelets is usually a problem associated to bone marrow functionality. In some conditions, the production of red blood cells and white blood cells may as well be affected. Common thrombocytopenia causes in adults include: Sulphonamide antibiotics, Idiopathic thrombocytopenic purpura (ITP), Thrombotic thrombocytopenic purpura (TTP), Hemolytic Uremic Syndrome (HUS), Splenic sequestration, Plastic anemia, Cancer, Immune thrombocytopenia, medication and bacterial infection in the blood.
Certain medications can affect the level of platelets in the blood. Some drugs when introduced into the body confuse the immune system that blood platelets are harmful materials, causing the body to fight them. Examples of these medications include heparin, anticonvulsants, quinine, and sulpha-containing antibiotics.
Sulphonamide antibiotics can lead to the destruction of platelets by reacting against them. Some other medications where changes in platelet count can be observed include carbamazepine, digoxin (Lanoxin), quinine (Quinerva, Quinite, QM-260), quinidine (Quinaglute, Quinidex), acetaminophen (Tylenol and others), and rifampin.
2. Idiopathic thrombocytopenic purpura (ITP)
Idiopathic thrombocytopenic purpura (ITP) is a condition where the body’s defense system abnormally attacks normal platelets. ITP can lead to a very low platelet count that is often a chronic condition in adults that may stay prolonged, whereas in children it develops acutely about after a viral infection.
3. Thrombotic thrombocytopenic purpura (TTP)
When small blood clots suddenly form throughout the body, a rare blood disorder called Thrombotic thrombocytopenic purpura (TTP) is most likely triggered. It causes the usage of large numbers of platelets, greater than what is necessary. TTP can cause non-immune consumptive thrombocytopenia secondary to infections, pregnancy, metastatic cancers, and chemotherapy. Other manifestations of the condition are kidney insufficiency, hemolytic anemia, and fever.
4. Hemolytic Uremic Syndrome (HUS)
Besides causing a sharp drop in platelets, the medical disorder causes a destruction of the red blood cells and impairs the functionality of the kidneys. In rare cases, it occurs after being infected with a bacterial Escherichia coli (E. coli), which can be acquired by eating undercooked meat.
5. Splenic sequestration
Splenic sequestration can lead to a low platelet count due to enlargement or altered function for various reasons. An enlarged spleen will store more than the usual amount of platelets leaving the circulating blood with lesser platelets. Causes of thrombocytopenia resulting from splenic enlargement include advanced liver diseases with portal hypertension, and some blood cancers.
6. Aplastic anemia
Aplastic anemia is a term used to identify a disorder where the bone marrow fails to form sufficient blood cells because of an underlying damage. This results to pancytopenia, which implies that the red blood cells, white blood cells, and the platelets are deficient. It could be a result of viral infection, medication, or radiation. Chemotherapy drugs can be a factor for it causes bone marrow suppression that usually results in thrombocytopenia. There are some drugs, such as thiazide diuretics, that can also suppress platelet production.
Cancers of the bone marrow and the blood, or cancers of the lymph nodes will also result in various levels of thrombocytopenia. Cancers of other body organs can also infiltrate the bone marrow resulting in a reduced production of blood platelets.
8. Immune thrombocytopenia
Immune thrombocytopenia is caused by autoimmune diseases such as lupus and rheumatoid arthritis. The immune system of the body mistakenly attacks normal cells, including the blood platelets, usually with a known cause. It is similar with Idiopathic thrombocytopenic purpura (ITP); only that the cause of the attack in ITP is not always known.
Thrombocytopenia as a blood disorder, can be inherited from parents, besides being caused by medical issues or conditions. Whichever the cause of the disorder, the extent of effect on the number of circulating platelets will vary. Due to the role played by platelets in the body, the entire system can be affected by the changes in the condition of platelets; especially the blood clotting process that requires adequate numbers of platelets to function properly.
10. Bacterial infection in the blood
Severe levels of bacterial infections in the blood also known as bacteremia will also lead to the destruction of platelets. The bacteria will feed on the blood cells including platelets, which will consequently lead to a reduced volume.
Reduced number of platelets can result from the trapping of platelets in an enlarged spleen, increased destruction of platelets, and decreased platelet production in the bone marrow.
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