Thrombocytopenia, the lack of platelets in the blood, can result from a variety of causes. Thrombocytopenia often occurs only in a weak form that does not require treatment, because the body can usually regulate the deficiency itself. The different types of thrombocytopenia have different symptoms and treatment options.
What is thrombocytopenia?
Thrombocytopenia refers to an insufficient amount of blood platelets, called thrombocytes, in the blood. While the human body normally has about 150,000 – 450,000 platelets per µl of blood, this value is undershot in thrombocytopenia. A distinction is made between congenital, acquired and artificially induced thrombocytopenia, with congenital thrombocytopenia occurring only rarely. Small deviations from the usual number of platelets usually do not lead to noticeable damage in the body. However, if the platelet count falls far below the normal number, visible damage and failure symptoms may occur at about 10,000 platelets per µl of blood or even less.
Causes
The causes of thrombocytopenia vary. One cause may be that the bone marrow is unable to produce enough platelets or that the body’s immune system is fighting the platelets. An enlarged spleen, in which too many platelets are filtered out, is also a possible cause. Since the spectrum of causes of thrombocytopenia is very wide, they are generally divided into 3 categories: Formation disorders, accelerated platelet degradation, and distribution disorders. In many cases, thrombocytopenia is not chronic, but occurs only temporarily until the body regulates the deficiency on its own. Severe thrombocytopenia most often occurs in association with autoimmune diseases, chemotherapy, or the use of specific medications and should definitely be monitored by a physician and treated if necessary.
Symptoms, complaints, and signs
Thrombocytopenia is not noticeable with general signs in the initial phase. Even when blood levels are significantly decreased, patients do not initially show any disturbance in well-being. A typical symptom of the disease is bleeding from small cuts, abrasions or scratches. The insufficient levels of platelets slow down the natural closure of the skin vessels. While five to six minutes are common in healthy people, it takes two to three times longer in sufferers. Some sufferers tend to experience nose or gum bleeding more often. Other common complaints are small, red spots and bloody patches in the subcutis. Others develop bruises conspicuously quickly, which appear even with harmless bumps. In women, there is also a specific complaint. Here it is the period, which is sometimes heavier than usual. If the laboratory data of the platelets are conspicuously low, the bleeding tendency can increase significantly. In these less common cases, bleeding mucous membranes form. If severe, they lead to dangerous gastrointestinal and other internal bleeding. Patients recognize this by the colored stool or urine. Immediately life-threatening are isolated cases of cerebral hemorrhage. The various symptoms of thrombocytopenia spread at different rates. Decisively, it depends on the patient’s diseases with which the disorder is associated.
Diagnosis and progression
Depending on the degree of thrombocytopenia, the body exhibits different symptoms. With minor abnormalities, the body usually shows no bleeding tendencies, but in isolated cases, there may be increased bleeding associated with injury. In advanced thrombocytopenia, there is an increased occurrence of bruising, known as microtrauma, as well as pinpoint bleeding of the skin on sensitive areas of the body. Severe thrombocytopenia is characterized primarily by frequent spontaneous bleeding of the skin and mucous membranes. Depending on the type of thrombocytopenia, bleeding into the brain and intestines, venous and arterial thrombosis, or even infarction and pulmonary embolism may occur without therapy.
Complications
In general, thrombocytopenia has a very negative effect on the daily life and quality of life of the affected person. However, the exact symptoms and complications of this disease depend very much on the severity of the thrombocytopenia. Those affected primarily suffer from bruising or bruising.These can occur in various parts of the body and possibly also lead to aesthetic discomfort for the patient. Furthermore, those affected often suffer from bleeding gums or nosebleeds and are thus restricted in their daily lives. Inflammation or pain may also occur. Furthermore, thrombocytopenia increases the risk of a heart attack or embolism, so that the affected person can also die from these complaints. However, this case occurs only very rarely. The treatment of thrombocytopenia always depends on the cause. As a rule, no particular complications occur and the symptoms can be limited. Transfusions may also be necessary. However, the further course depends strongly on the underlying disease. It cannot be universally predicted whether this will result in a reduced life expectancy for the patient due to thrombocytopenia.
When should you see a doctor?
If nosebleeds occur repeatedly or hematomas form, thrombocytopenia may be underlying. A visit to the doctor is indicated if the symptoms seem to occur for no reason or are accompanied by other symptoms such as blood in the stool, urine, or cough. If bleeding cannot be stopped, punctiform bleeding occurs in the skin or a general feeling of malaise is noticed, medical advice is required. Patients at risk include those who have had a blood transfusion, suffer from Acute Respiratory Distress Syndrome or connective tissue disease. Drugs, infections or medical complications such as sepsis can also cause thrombocytopenia. One in 20 pregnant women suffers from asymptomatic thrombocytopenia in the last trimester, which also needs to be promptly evaluated and treated. Thrombocytopenia is treated by the family physician or the cardiologist. In severe cases, such as sepsis or rickettsial infections, the emergency physician must be called. Because those affected are anemic, a quick response is needed to prevent major health complications.
Treatment and therapy
Treatment of thrombocytopenia depends on the underlying cause. Thrombocytopenia that is merely acute will resolve on its own after a few weeks and is usually not treated. Acute thrombocytopenia, on the other hand, can last for several years and is classified and treated based on the cause, the degree of bleeding, and the platelet count. Treatment of thrombocytopenia focuses on stopping bleeding from the skin and mucous membranes using medications and reducing factors that promote bleeding, as well as increasing the number of platelets to prevent new bleeding. If symptoms indicate a frequent tendency to bleed, hospitalization and observation are recommended. If internal bleeding is suspected or chronic bleeding occurs, emergency treatment may be required. In case of severe chronic symptoms, transfusion of platelets is performed, which are added to the bloodstream. Removal of the spleen is also considered as a possible therapy, although organ removal is increasingly rejected due to long-term risks and susceptibility to infection. Another option is the administration of special antibodies or synthetic peptides that stimulate platelet production.
Prevention
Currently, there are no known preventive measures for thrombocytopenia. However, in severe cases of thrombocytopenia, early recognition and early treatment of symptoms can help regulate platelet deficiency as quickly as possible. In the case of more frequent than normal spontaneous bleeding, such as nosebleeds and bleeding gums, or punctate small skin bleeding on the body, a doctor should be consulted. The possibility of thrombocytopenia increases especially in connection with pregnancy, taking heparin to inhibit blood clotting, and during chemotherapy.
Follow-up
Affected individuals have limited measures of follow-up care available for thrombocytopenia in most cases because it is a rare condition. If the disease has been present since birth, it usually cannot be completely cured. Therefore, if the affected person wishes to have children, he or she should have genetic testing and counseling to prevent the recurrence of the disease. As a rule, there can be no independent cure.Most of those affected are dependent on surgical intervention. After such an operation, the patient should definitely rest and take care of his body, keeping a strict bed rest and avoiding stressful or physical activities. In many cases, the support and help of one’s family is also necessary to avoid depression or psychological upsets. Whether thrombocytopenia will result in a reduced life expectancy for the affected person cannot be universally predicted. Contact with others affected by the disease is often useful, as it can lead to an exchange of information.
What you can do yourself
A balanced diet helps to noticeably increase the number of platelets. Fresh vegetables and fruit stimulate the body’s own production of new platelets. Foods such as oranges, tomatoes, kiwis and green vegetables have a particularly positive effect. In contrast, processed foods, such as sugar and flour, as well as cookies and soda, impair the body’s important clotting function. High-quality omega-3 fatty acids can stimulate platelet production. Increased consumption of fatty fish such as salmon or mackerel, rapeseed oil or linseed oil, and eggs and nuts are therefore particularly recommended. In order to increase the platelets, those affected should also pay attention to their beverage consumption. In particular, it is recommended to avoid alcohol and caffeinated beverages. Instead, lukewarm water stimulates nutrient absorption in the body. As a result, a higher quantity of blood cells is produced. Green tea, white ginseng and olive leaves also have a positive effect on the production of blood platelets. In addition to a balanced diet, exercise can stimulate the production of platelets. Exercise strengthens the immune system as well as the circulatory system. This helps the body to produce the necessary platelets more easily. However, it is important to choose the type of sport carefully. This is because patients tend to bleed heavily. For this reason, contact sports should be avoided. Gentle endurance training is better.
