Bruises are a normal part of life and can become more common as we age. Although most bruises aren’t much to worry about, some bruising could be a sign of a more serious problem known as thrombocytopenia.
If you’ve been experiencing some unexplained bruising or mild to serious bleeding, read on to learn more about this condition.
What is thrombocytopenia?
Thrombocytopenia is any disorder in which there is an abnormally low platelet level in your blood. Broken down, “thrombo” is a Greek word that refers to blood clotting, “cyto” means cell, and “penia” means deficiency.
“People who have thrombocytopenia don’t have enough platelets, the part of the blood that helps blood clot,” Jeffrey J. Pu, MD, PhD, medical director of the adult Hematopoietic Cellular Therapy and Transplantation (HCTT) program at Banner - University Medical Center Tucson and associate director for the University of Arizona Cancer Center HCTT program. “As a result, they may bleed too much if they get an injury or cut, internally or externally.”
A normal platelet count in adults ranges from 150,000 to 450,000 platelets per microliter of blood. When a platelet count drops below 150,000, you have thrombocytopenia.
Who gets thrombocytopenia?
It’s unknown how many people have thrombocytopenia, but the following may increase your risk for developing it:
- Alcohol use disorder and alcoholism
- Autoimmune diseases, such as lupus, which can cause idiopathic thrombocytopenia purpura, or ITP
- Bone marrow diseases, including aplastic anemia, leukemia, certain lymphomas and myelodysplastic syndromes
- Certain medications
- Cancer treatments like chemotherapy and radiation therapy
A low platelet count can also occur during the last trimester of pregnancy, although the cause may not be known.
What are the signs of thrombocytopenia?
If you have a mild case of thrombocytopenia, you may not experience any symptoms. However, some of the signs and symptoms of a low platelet count to watch out for include:
- Easy or excessive bruising, called purpura
- A rash with small red or purple dots, called petechiae, which is usually seen on the lower part of the legs
- Bleeding from your gums or nose
- Prolonged bleeding after getting a cut
In more severe cases, symptoms may include blood in your stool, urine or vomit.
How is thrombocytopenia diagnosed?
It’s important if you’re experiencing any of the above symptoms, or have concerns, that you address them with your health care provider. Your provider will perform a physical exam, go over your medical history and may run some blood tests, including a complete blood count, to check your platelet counts.
If your blood platelet count falls below normal, your provider will begin looking for its cause and may refer you to a hematologist who specializes in diagnosing and treating blood diseases and conditions.
How is thrombocytopenia treated?
Having a low platelet count may come with a lot of worry about your potential risk for bleeding, but it doesn’t always come with problems or will require treatment.
If you have mild thrombocytopenia and it isn’t causing symptoms, your health care provider may monitor your platelet counts and ask that you report back on any symptoms of bleeding or bruising.
“Treatment depends on the severity and the condition that is causing it,” Dr. Pu said. “If platelets are low enough and require some form of treatment, there are also multiple options available, from oral and intravenous medication to surgical options.”
If your thrombocytopenia is more severe, treatment options may include:
Medication avoidance. If you’re experiencing thrombocytopenia due to a reaction to a medication, stopping that medication may be the only treatment required. You may also have to avoid, or use with caution, other medications that affect platelet function.
“Some of the most common medications that may need to be discontinued or avoided include heparin, aspirin, ibuprofen, naproxen, blood thinners like warfarin, Eliquis or Xarelto and Plavix,” Dr. Pu said. “However, don’t discontinue any medications without the guidance or instruction of your prescribing health care provider.”
Prescribing medications. If your low platelet count occurs due to an autoimmune disorder or abnormal destruction of platelet cells, your health care provider may prescribe steroids like prednisone to decrease your immune system’s reaction and keep it from attacking the platelets. “These are typically given through IV or taken orally by pill and are tapered off as your counts improve,” Dr. Pu said.
Your health care provider may also prescribe immune globulin intravenous infusion (IVIG) (injection) to slow down your immune system’s destruction of platelets. “IVIG may be given in combination with steroids or as a second-line therapy if steroids alone aren’t working well enough,” Dr. Pu said. Certain medications, such as Promacta (eltrombopag) and Nplate (romiplostim), can be prescribed to help increase platelet production in the bone marrow as well.
Blood and platelet transfusions. An infusion of donated platelets or blood is used to treat people who have active bleeding, are at high risk for bleeding or require surgery. Transfusing one unit of platelets can increase your platelet counts by 30,000 to 60,000 per deciliter of blood.
Antibody Therapy. An antibody called Rituxan can be infused to help improve platelet counts. Rituxan works by helping the immune system stop destroying platelets abnormally. This infusion can be given weekly for a few weeks to improve platelet counts.
Surgical options. If nonsurgical treatments aren’t successful at increasing your platelet counts, a splenectomy to remove your spleen may be necessary.
“The spleen is the location that platelets are removed from the body when being attacked by the immune system, so removing the spleen may significantly improve platelet counts,” Dr. Pu said. “However, there are risks associated with surgery, and a splenectomy can increase your risk for future infections.”
Lifestyle changes. If you’re at risk of developing a low platelet count due to an underlying condition, your health care provider may recommend certain lifestyle changes and preventative measures. These may include:
- increasing vitamin B12 or folate
- limiting or avoiding alcohol completely
- making dietary changes
- avoiding certain activities that may increase the risk of bleeding, such as contact sports
Are there any complications I should be concerned about?
Many people with thrombocytopenia have mild to moderate symptoms. However, a low platelet count can increase your risk for hemorrhaging or severe bleeding, both of which can be life-threatening. Talk with your health care provider to create a prevention and treatment plan.
You can also take steps to avoid health problems related to thrombocytopenia, watch the medications you take, avoid injuries and contact your health care provider if you notice any changes in symptoms.
Seek emergency treatment if you have low platelets and are experiencing bleeding or are having difficulty stopping bleeding.
To find a Banner Health specialist near you, visit bannerhealth.com.
