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Thrombocytopenia (bleeding from low platelets)

Last update: 12/29/2015

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Low Platelets | Tips to Avoid Bleeding Complications | Causes |
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See also Low Blood Counts

Low platelets (thrombocytopenia) is a decreased number of platelets in the blood that increases the risk of bleeding - internal or external.  The normal platelet counts vary by age and gender.  See Peripheral Blood Reference Range PDF

Causes: Low platelets is a common and reversible side effect of chemotherapy and radiotherapy treatments for lymphoma and other cancers. It may be caused by decreased platelet production by the bone marrow (due to lymphoma in the marrow or damage to the marrow); increased trapping of platelets by the spleen; or a more rapid than normal destruction of platelets.

When the cause is unknown it may be called Idiopathic or Immune Thrombocytopenia (ITP)

"ITP is defined as isolated thrombocytopenia with no clinically apparent associated conditions or other causes...

This definition provides the basis for the initial patient evaluation. No specific criteria establish the diagnosis of ITP; the diagnosis relies on the exclusion of alternative disorders, such as the examples listed in Table 1.

... Exclusion of recognized alternative etiologies (causes) of thrombocytopenia was the basis for the original name for ITP, idiopathic thrombocytopenic purpura.

A current perspective has proposed the name primary immune thrombocytopenia for ITP, to distinguish ITP from identifiable alternative secondary etiologies. "

Source: Definition, diagnosis and treatment of immune thrombocytopenic purpura

Persons with this condition easily bruise and can have episodes of excess bleeding (a hemorrhage). See conditions that can cause thrombocytopenia below, and tips for preventing problems associated with this condition.

Signs & symptoms:  Thrombocytopenia can cause an increased susceptibility to bleeding, as platelets are essential to blood clotting.  A differential diagnosis is a systematic (step-by-step) method used to identify the cause of the condition where multiple reasons are possible.

According to the Merck Manual, "bleeding in the skin may be the first sign of a low platelet count. Many tiny red dots often appear in the skin on the lower legs, and minor injuries may cause small scattered bruises. The gums may bleed, and blood may appear in the stool or urine. Menstrual periods may be unusually heavy. Bleeding may be hard to stop." 

Also according to the Merck Manual:  "
Dangerous internal bleeding can occur when your platelet count falls below 10,000 platelets per microliter. Though rare, severe thrombocytopenia can cause bleeding into the brain, which can be fatal."

If you have a low platelet count, and are in need of treatment, it may be necessary for you to have a platelet transfusion.  See for details: cancerbackup.org.uk 


Tips for reducing risk of bleeding from low platelets:

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Avoid medications, such as aspirin, and herbal supplements, such as fish oil, vitamin E, and Ginko) that may thin the blood or contribute to bleeding.

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Avoid alcoholic beverages.

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Use a very soft toothbrush when cleaning teeth; and avoid brushing vigorously.

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When cleaning your nose avoid blowing your nose, or blow very gently into a soft tissue.

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Try to avoid injury when using tools, scissors, needles, knives, or when shaving.

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When shaving use an electric shaver instead of a razor. Add corn starch to skin before shaving with it.

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Take extra care when preparing foods or using appliances that can burn. 

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Avoid or curtail activities that might result in injury, including sexual activity.

Many conditions can cause thrombocytopenia:

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Radiation therapy or chemotherapy destroys megakaryocytic, the precursor cells that produce platelets in the bone marrow.  Topic search: Medscape 
 
See also MDS

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Genetic abnormalities, may impair production of normal platelets. 

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A cancer, such as lymphoma, in the bone marrow can inhibit production of platelets.

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Aplastic anemia can impair platelet production. 

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Certain drugs, especially thiazide diuretics or alcohol, depresses production of precursor cells that produce platelets in the bone marrow. 

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Short-term low platelets is also associated with some viral infection.

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Autoimmune disease called Idiopathic thrombocytopenic purpura (ITP) can cause the body to destroy platelets. Other autoimmune diseases, such as systemic lupus erythematosus (SLE), polyarteritis and dermatomyositis, can cause thrombocytopenia. 

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In individuals with AIDS, thrombocytopenia commonly appears before other symptoms. 

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Drug-induced thrombocytopenia can be caused by any medication commercially available, but somewhat frequently by valproic acid (Depakote), gold salts, heparin (Calciparine, Liquaemin) and several other medications.

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Thrombotic thrombocytopenic purpura (TTP) a rare disease that causes low platelets, in addition to a variety of other symptoms and complications.   See itppeople.com | acor.org  

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"Individuals with liver disease develop a large spleen. As this process occurs platelets are trapped with in the sinusoids (small pathways within the spleen) of the spleen. While the trapping of platelets is a normal function for the spleen, in liver disease it becomes exaggerated because of the enlarged spleen (splenomegaly). Subsequently, the platelet count may become diminished."  - http://www.gastromd.com/lft.html 

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Abnormalities in the spleen, such as cancer, cirrhosis, or Gaucher's disease, may cause abnormal amounts of platelets to be taken up by the spleen, which under normal conditions contains about one-third of the platelets in the body.  

Recommended Resources:

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Thrombocytopenia - American Family Physician http://bit.ly/1JeedTH
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Thrombocytopenia (low platelet count) - MayoClinic.com
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Managing Low Platelets lrcc.on.ca
Excellent guidelines provided here.
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About platelet transfusions cancerbackup.org.uk 
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Definition, diagnosis and treatment of immune thrombocytopenic purpura

(low platelets caused by autoimmune disease)
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Thrombotic Thrombocytopenic Purpura - Differential Diagnosis - vhct.org
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Platelets: Thrombotic Thrombocytopenic Purpura - Comprehensive review  asheducationbook.org   

Related Topics: 

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Biologics |  IL-11 (oprelvekin) Neumega 
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CBC - Complete Blood Count
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Chemotherapy treatment support 
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Avoiding Trouble - general | Avoiding Infections Page
Diet for Immune suppressed Page
|
Fight nausea
Fight Constipation | Oral HealthWhen to call your doctor
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Low platelets 
Quick Reference

(Thrombocytopenia)

Makes you susceptible to bleeding

Approximate normal range:
130-400 (x109/l)

Normal range may vary for different labs

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Resources & Research News

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Autoimmune thrombocytopenia associated with the first cycle of fludarabine therapy in the treatment of relapsed non-Hodgkin's lymphoma  PubMed
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B-cell depletion with rituximab as treatment for immune hemolytic anemia and chronic thrombocytopenia. Haematologica. 2002 Feb;87(2):189-95.  PubMed
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Drug info: Neumega
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ITP - Immune (Idiopathic) Trombocytopenic Purpura -
itppeople.com
 | ACOR.org  
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Help with platelet recovery? Use of physiological doses of human growth hormone in haematological patients receiving intensive chemotherapy promotes haematopoietic recovery: a double-blind randomized, placebo-controlled study  PubMed  2007

Treatment with hGH in physiological doses improves platelet recovery, but is not associated with a lower relapse rate or improved anthropometric parameters in patients receiving intensive chemotherapy.
 
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professional medical advice or to replace your relationship with a physician.
For all medical concerns,  you should always consult your doctor. 
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