What is thrombocytopenia?
If the number of platelets is very low, it is called thrombocytopenia (thrombocytopenia). When there are too few platelets in the blood, hemostasis is impaired and bleeding is prolonged and more frequent. In some cases, bleeding can occur in the body without an injury.
Thrombocytopenia: Causes
A low platelet count can result from a variety of congenital or acquired mechanisms. Sometimes, too few platelets are formed in the bone marrow. Such a formation disorder is usually acquired (e.g., in leukemia, vitamin B12 deficiency, or lead poisoning) and only very rarely congenital (e.g., Wiscott-Aldrich syndrome).
A distribution disorder may also be behind platelet deficiency: When the spleen is overly active (hypersplenism), a large proportion of platelets are redistributed to the spleen and broken down there. Hypersplenism is usually a complication of an enlarged spleen (splenomegaly). People with liver cirrhosis, for example, may be affected.
Another cause of thrombocytopenia is thinning or increased loss of platelets in cases of very heavy bleeding.
Summary: Important causes of thrombocytopenia
- massive bleeding
- severe infections (e.g. hepatitis, malaria)
- tumor diseases (e.g. blood cancer = leukemia, myeloproliferative neoplasms, metastases in the bone marrow)
- certain rheumatic diseases
- Vitamin deficiency (deficiency of vitamin B12 or folic acid)
- Immune thrombocytopenia (Werlhof’s disease, formerly also called ITP = idiopathic thyrombocytopenic purpura)
- TTP (thrombotic thrombocytopenic purpura or Moschcowitz disease)
- bone marrow damage, e.g. by drugs, alcohol, ionizing radiation
- congenital educational disorders (e.g. Wiscott-Aldrich syndrome, Fanconi anemia)
- toxins, drugs (e.g. heparin)
- pregnancy
- erroneous measurements
Symptoms of thrombocytopenia
Thrombocytopenia: examinations and diagnosis
Symptoms such as spontaneous bleeding and frequent bruising often lead a physician to suspect a deficiency of platelets. Blood tests can confirm the suspicion. They often also provide an indication of the cause of the thrombocytopenia. However, further tests may be necessary for clarification.
For example, the physician can take a sample of the patient’s bone marrow and send it to the laboratory for analysis. This is necessary, for example, if leukemia is suspected. The bone marrow examination is also informative if immune thrombocytopenia is suspected: in this case, young precursor cells of the thrombocytes are found in the bone marrow.
How is thrombocytopenia treated?
The therapy of thrombocytopenia depends on the cause and severity of the reduced platelet count. Particularly in the case of infections, the platelet count regulates itself quickly after the infection has subsided. The platelet count also increases again by itself after pregnancy.
If the thrombocytopenia finding is due to medications, these must be discontinued if possible to prevent worsening. If the thrombocytopenia is due to increased platelet depletion in the spleen, the spleen may need to be removed.
Treatment of thrombocytopenia in severe cases takes place in the hospital. Patients can be well monitored there. In the event of internal bleeding, a doctor can then intervene quickly.
