Thrombocytopenia is a blood disorder characterized by abnormally low platelet counts, leading to an increased risk of bleeding. Platelets, also called thrombocytes, play a vital role in blood clotting by forming plugs at sites of injury. A normal platelet count ranges from 150,000 to 400,000 per microliter of blood. When the count drops below 150,000/µL, the condition is termed thrombocytopenia, and the risk of uncontrolled bleeding rises significantly.
This article provides a comprehensive overview of thrombocytopenia—covering pathology, causes, symptoms, diagnosis, management strategies, and a closer look at immune thrombocytopenic purpura (ITP).
Pathology of Thrombocytopenia
Platelets are small blood components responsible for clot formation and prevention of bleeding. They aggregate (clump together) at sites of vascular injury to form a hemostatic plug.
- In thrombocytopenia, platelet levels fall below 150,000/µL.
- Severe thrombocytopenia (<20,000/µL) increases the risk of spontaneous bleeding, even without trauma.
- The lower the platelet count, the greater the bleeding risk.
Causes of Thrombocytopenia
The causes can be remembered with the mnemonic PLATELETS:
- Platelet disorders
- Leukemia
- Anemia
- Trauma
- Enlarged spleen (splenomegaly)
- Liver disease
- Ethanol (alcohol-induced)
- Toxins (drug-induced, e.g., chemotherapy, antibiotics)
- Sepsis
Other factors include:
- Autoimmune conditions (e.g., lupus).
- Viral infections (HIV, hepatitis, EBV).
- Pregnancy-related thrombocytopenia.
Symptoms of Thrombocytopenia
The clinical manifestations are related to impaired clotting and bleeding:
- General symptoms: Weakness, dizziness, tachycardia, hypotension.
- Prolonged bleeding: From cuts, gums, or nose.
- Petechiae: Pinpoint red spots on the skin from tiny blood vessel bleeding.
- Purpura: Larger areas of purple bruising.
- Heavy menstrual cycles (menorrhagia).
- Blood in urine or stool.
- Easy bruising and delayed wound healing.
- Laboratory findings: ↑ INR, ↑ PT/PTT, ↓ Hemoglobin & Hematocrit.
Diagnosis of Thrombocytopenia
To confirm thrombocytopenia, doctors use clinical evaluation and laboratory tests:
- Platelet count: <150,000/µL.
- Bleeding time: Prolonged.
- aPTT (Activated Partial Thromboplastin Time): Assesses intrinsic pathway.
- PT (Prothrombin Time): Assesses extrinsic pathway.
- INR (International Normalized Ratio): Evaluates clotting tendency.
- Peripheral blood smear: Identifies abnormal platelet morphology.
- Bone marrow biopsy: To check for production disorders (aplastic anemia, leukemia).
Nursing Management of Thrombocytopenia
Nurses play a vital role in preventing bleeding and managing complications.
Key Interventions
- Platelet transfusions – For severe thrombocytopenia or active bleeding.
- Bone marrow transplant – For bone marrow failure syndromes.
- Splenectomy – If the spleen is destroying platelets and unresponsive to medical therapy.
- Monitor vital signs and bleeding risks regularly.
- Educate patients on avoiding activities that may cause injury.
Bleeding Precautions
Patients with thrombocytopenia are at risk for internal and external bleeding. Precautions include:
- Use electric razors instead of blades.
- Avoid aspirin or NSAIDs (increase bleeding risk).
- Use small gauge needles and minimize injections.
- Reduce needle sticks by clustering care.
- Protect patient from falls and injuries.
These precautions greatly reduce the risk of spontaneous or trauma-induced bleeding.
Immune Thrombocytopenic Purpura (ITP)
Immune Thrombocytopenic Purpura (ITP), formerly known as idiopathic thrombocytopenic purpura, is a specific autoimmune cause of thrombocytopenia.
Pathology
- The body’s immune system produces antibodies against platelets, destroying them prematurely.
- Platelet counts fall below 20,000/µL.
- Results in easy bruising, petechiae, and mucosal bleeding.
Causes of ITP
- Occurs in children following viral infections.
- More common in females aged 20–40 years.
- May develop during pregnancy.
Management of ITP
- Corticosteroids (e.g., prednisone) – reduce immune destruction of platelets.
- IV immunoglobulin (IVIG) – blocks antibody-mediated platelet destruction.
- Splenectomy – in chronic, refractory cases.
- Immunosuppressants – azathioprine, rituximab for resistant cases.
Key Differences: Thrombocytopenia vs ITP
| Feature | Thrombocytopenia | Immune Thrombocytopenic Purpura (ITP) |
|---|---|---|
| Cause | Multiple (bone marrow, liver disease, sepsis, drugs) | Autoimmune (antibodies against platelets) |
| Platelet Count | <150,000/µL | Often <20,000/µL |
| Onset | Secondary to illness | Can occur after viral infection or idiopathic |
| Age group | All ages | Children, females 20–40, pregnancy |
| Management | Platelet transfusion, splenectomy, bone marrow care | Corticosteroids, IVIG, splenectomy if refractory |
Frequently Asked Questions (FAQ)
Q1: What is the danger of thrombocytopenia?
The greatest risk is uncontrolled bleeding, which can be internal (GI bleeding, brain hemorrhage) or external.
Q2: When do you need a platelet transfusion?
Usually when platelet counts drop below 20,000/µL or when active bleeding occurs.
Q3: Can medications cause thrombocytopenia?
Yes. Certain drugs like chemotherapy agents, antibiotics, and alcohol can damage bone marrow or accelerate platelet destruction.
Q4: How is ITP different from leukemia-related thrombocytopenia?
In ITP, platelets are destroyed by antibodies, whereas in leukemia, bone marrow fails to produce adequate platelets.
Q5: Can thrombocytopenia be cured?
Treatment depends on the cause. Reversible cases (drug-induced, infection-related) resolve with treatment, while chronic autoimmune cases like ITP may require long-term management.
