Thrombocytopenia

Thrombocytopenia occurs when there are fewer platelets in the blood than normal. Platelets (also called thrombocytes) are blood cells that are needed for clotting. They help stop or control bleeding when you have a cut or wound. Thrombocytopenia can range from mild to severe. This depends on the number of platelets in your blood. If you have severe thrombocytopenia, you’re at higher risk for bruising and bleeding. Your doctor can tell you more about your condition and whether it needs to be treated.

Microscopic view of blood with normal amount of platelets. Microscopic view of blood with too few platelets.

Causes of thrombocytopenia

Platelets and other blood cells are made in the bone marrow. This is the soft, spongy part inside bones. Thrombocytopenia can result when:

  • The bone marrow doesn’t make enough platelets.

  • Platelets are destroyed by the body at a rate faster than they can be made in the bone marrow.

  • Platelets become trapped in an enlarged spleen.

These problems can occur due to many reasons, including:

  • Certain conditions that affect how platelets are made in the bone marrow, such as aplastic anemia, leukemia, and lymphoma

  • Certain medications, such as some types of antibiotics, anti-seizure medications, and chemotherapy drugs

  • Certain viral infections, such as varicella (chicken pox), HIV, and Epstein-Barr virus

  • Certain autoimmune problems, such as lupus and immune thrombocytopenic purpura (ITP)

  • Certain conditions that can cause an enlarged spleen, such as cirrhosis and cancer

  • Alcohol abuse

  • Pregnancy

Symptoms of thrombocytopenia

Possible symptoms include:

  • Severe bruising or bleeding

  • Small red or purple spots (petechiae) on the skin

  • Bleeding gums

  • Nosebleeds

  • Bleeding from a wound that stops and starts again

  • Bloody urine or stool

  • Heavy menstrual flow (women only)

Diagnosing thrombocytopenia

Your doctor will ask about your symptoms and health history. You will also be examined. Tests will be done to confirm the problem as well. These may include:

  • A complete blood cell count (CBC). This test measures the amounts of the different types of cells in the blood. This includes the number of platelets in the blood (platelet count).

  • A blood smear. This test checks for the different types of blood cells in the blood and how they appear. A sample of your blood is spread on a glass slide and viewed under a microscope. A stain is used so the blood cells can be seen.

  • A bone marrow aspiration and biopsy. This test checks for problems with how the bone marrow makes blood cells. A needle is used to remove a sample of the bone marrow in your hip bone. The sample is then sent to a lab to be tested for problems.

Treating thrombocytopenia

Often, no treatment is needed for thrombocytopenia. Your doctor will monitor your symptoms to see if they improve. Blood tests will also be done to check whether your platelet count returns to normal on its own. If treatment is needed, this may involve:

  • Treatment of the underlying cause. For instance, if a medication is the cause, it may be stopped or changed.

  • Platelet transfusions. These help raise the number of healthy platelets in the body.

  • Blood transfusions. These help treat blood loss that may occur because of low platelets.

  • Medications. These may be given to help prevent platelets from being destroyed. These may also be given to help the bone marrow make more platelets.

  • Surgery to remove the spleen. The spleen helps filter the blood. It also stores some blood cells, including platelets. If the spleen is enlarged, it can store too many platelets. This causes there to be fewer platelets in the blood than normal. Though done less often, removing the spleen may help treat thrombocytopenia in certain cases.

Recovery and follow-up

Thrombocytopenia may be a short-term (acute) problem that has no lasting effects. Or it may be an ongoing (chronic) problem. If your condition is chronic, you may need specific treatments to manage it. You may also need to take certain steps daily to reduce your risk of bleeding. For instance, you may be told to limit certain activities that increase your risk of injury. You may also be told to avoid drinking alcohol and taking certain medications, such as aspirin and ibuprofen. These can worsen your symptoms. In addition, you will need to know and watch for signs and symptoms of bleeding. These are described in more detail in the box below.

When to call the doctor

Call your doctor right away if you have any of the following:

  • Severe bleeding that won’t stop (call 911)

  • Signs that might be seen with bleeding in the brain, such as severe headache, dizziness, trouble with balance and coordination, abnormal walk, memory loss, and confusion (call 911)

  • Bruising that spreads or worsens

  • Increase of small red or purple spots (petechiae) on the skin

  • Bloody urine

  • Dark brown or black, tarry, or bloody stools

  • Bloody vomit



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