Platelets
Thrombocytopenia is a disorder caused by a low number of platelets in the blood. Platelets are also called thrombocytes. They are made in the bone marrow and help the blood to clot. People with low platelet counts may bleed or bruise more easily, even after a minor injury. Thrombocytopenia increases the risk of bleeding, especially from the mouth, nose and digestive tract.
Normal platelet counts can vary by lab. In general, the reference value of platelets is between 150,000 and 300,000/mm3. A person has thrombocytopenia when their platelet count is less than 150,000/mm3.
Causes
Thrombocytopenia can occur if the bone marrow does not function normally and does not produce enough platelets. Some cancers, such as leukemia, can cause thrombocytopenia. The following cancer treatments may also affect the bone marrow and lead to a low platelet count:
chemotherapeutic agents, biological drugs and others
radiation therapy to the pelvis or a large amount of bone marrow
A person can also have thrombocytopenia if their spleen is swollen (hypersplenism) or if cancer has spread to the spleen. The spleen makes lymphocytes, a type of white blood cell that fights germs, foreign substances and cancer cells. It also stores blood cells, filters the blood and destroys old blood cells. When the spleen is swollen, it removes too many platelets from the bloodstream, causing them not to travel throughout the body.
Symptoms
Symptoms of thrombocytopenia usually do not appear until the platelet count is very low. They may start soon after you start chemotherapy, but they are usually most present 10 to 14 days after you receive your first chemotherapy session.
Symptoms of thrombocytopenia include the following:
bruising tendency
- appearance of tiny reddish dots under the skin (petechiae).
- unusual bleeding from the gums or nose.
- heavy or long-lasting bleeding from a small cut or injection site.
- blood in the urine, which may look pink, red, or brown.
- blood in the stool or black stools.
- vomiting bloody or resembling ground coffee.
- vaginal bleeding that is different from normal menstruation and lasts longer.
- constant headaches, slightly blurred vision, or changes in level of consciousness.
- Thrombocytopenia caused by chemotherapy is usually temporary but can cause severe blood loss or bleeding that can damage internal organs.
Diagnostic
Your doctor will try to find the cause of the thrombocytopenia. He may therefore ask you questions about your symptoms, the medications you are taking and the treatments you have received. Your doctor will also do a physical exam.
Thrombocytopenia is usually diagnosed by:
- drawing blood to check platelet count, bleeding rate and clotting time;
- doing a bone marrow aspirate and biopsy to determine the underlying cause (if not already known).
- Prevention of bleeding and bruising
- It can be difficult to prevent thrombocytopenia when it is caused by cancer or chemotherapy. The following measures may help you prevent bleeding and bruising if your platelet count is low.
Have good oral hygiene
- Rinse and brush your teeth after eating. Brush them gently with an ultra-soft bristle brush, a mouth swab (Toothette), a cotton swab or gauze to prevent your gums from bleeding. Soften your toothbrush with warm water before each use.
- Be careful and very gentle when flossing. Avoid areas that bleed easily. The healthcare team may recommend that you do not floss until your platelet count has returned to normal.
- Apply balm or petroleum jelly to your lips to keep them moist and prevent cracking.
- Consult your healthcare team before having any dental work done.
Protect your body
Avoid engaging in contact sports or activities that could cause injury or bruising. Consult your healthcare team before using complementary therapies that use pressure or massage techniques, such as acupuncture, shiatsu, yoga and chiropractic. Also ask them if you should take any precautions when you have sex when your platelet count is low.
Bendyour knees and squat instead of bending over. This keeps your head above heart level and helps prevent additional pressure from being put on the blood vessels in the head and neck.
If a child's platelet count is low, refill their bed, crib, and playpen.
Regularly apply moisturizing lotion to your skin to keep it moist. Use an electric razor rather than a disposable razor to prevent cuts. Wear protective gloves when working in the garden or near plants that have thorns.
Be very careful when handling a knife or any type of sharp tool. Avoid burning yourself when ironing or cooking. Use potholders instead of potholders when removing hot food from the oven.
Before receiving an injection into a muscle (intramuscular), consult your doctor.
Use pads instead of tampons during menstruation. Do not use suppositories, enemas or rectal thermometers. Avoid blowing your nose hard.
Avoid sharp, crunchy, spicy or acidic foods. Eat soft foods like soup, mashed potatoes, custard, jello, and puddings. Do not drink alcohol. Drink plenty of fluids and eat enough fiber to avoid constipation. Try not to strain when you have a bowel movement. If you are constipated, ask your doctor if you can take a softening product.
Talk to your care team
Don't take any over-the-counter medications, such as painkillers and cold medicines, without first talking to your doctor. These medications may contain aspirin or other agents that can weaken platelets and make bleeding problems worse.
Treatment of bleeding
Contact your healthcare team if any of the following bleeds get worse or cannot be controlled after 10 minutes.
Nosebleed
If you have a nosebleed, sit down and tilt your head slightly forward. Apply a cold water compress to your nose, pressing both sides continuously for 10 minutes. You can also apply a cold compress to your neck.
Bleeding gums or mouth
If you can easily reach the bleeding area, apply gentle pressure until the bleeding stops. If you can't apply pressure to the area, keep ice water in your mouth or suck on a popsicle or ice cubes until the bleeding stops.
Bleeding from a cut
Apply pressure to the cut with a clean, dry cloth for at least 10 minutes. If possible, raise the injured body part above heart level. Do not apply a tourniquet to control the bleeding as it can cause permanent tissue damage.
Bleeding under the skin that stretches or swells
Apply light but firm pressure to the area with a soft cloth or ice pack for at least 10 minutes. Raise the area above the level of the heart if possible.
Treatment of low platelet count
If the cancer lowers the number of platelets, we try everything to treat the cancer. However, the treatment itself can cause thrombocytopenia. When chemotherapy lowers the number of platelets, the dose may need to be reduced or the interval between each chemotherapy cycle increased.
If your platelet count is below 20,000/mm3 and you are bleeding or bruising a lot, you may need a platelet transfusion. As it only lasts about 3 days, some people may need more than one transfusion.
Fever and infections can increase the body's need for platelets. Medicines may be given before the transfusion to reduce the fever and clear up the infection so that the body does not need as many platelets.
The healthcare team may also give you medicine to help your body make more platelets. They are growth factors. An example is interleukin 11. Growth factors can help prevent severe thrombocytopenia.
