Thrombocytopenia

1. Thrombocytopenia
   
   
    is any disorder in which there is an abnormally low amount of platelets. Platelets are parts of the blood that help blood to clot. This condition is sometimes associated with abnormal bleeding.
   Thrombocytopenia often occurs as a result of a separate disorder, such as leukemia or an immune system problem, or as a medication side effect. Thrombocytopenia may be mild and cause few signs or symptoms. In rare cases, the number of platelets may be so low that dangerous internal bleeding can occur. 
   
   
   Causes
   Thrombocytopenia is often divided into three major causes of low platelets:
   1.     Not enough platelets are made in the bone marrow
   2.     Increased breakdown of platelets in the bloodstream
   3.     Increased breakdown of platelets in the spleen or liver
   Your bone marrow may not make enough platelets if you have:
   
   A plastic anemia
   Cancer in the bone marrow such as leukemia
   Cirrhosis (liver scarring)
   Folate deficiency
   Infections in the bone marrow (very rare)
   Myelodysplasia
   Vitamin B12 deficiency
   The following health conditions cause increased breakdown of platelets:
   
   Disseminated intravascular coagulation (DIC)
   Drug-induced no immune thrombocytopenia
   Drug-induced immune thrombocytopenia
   Hypersplenism (swollen spleen)
   Immune thrombocytopenic purpura (ITP)
   Thrombotic thrombocytopenic purpura
   
   
   
   
   Symptoms
   You may not have any symptoms. General symptoms include:
   
   Bleeding in the mouth and gums
   Bruising
   Nosebleeds
   Rash (pinpoint red spots called petechia)
   Other symptoms depend on the cause.
   Often, low platelet levels do not lead to clinical problems; rather, they are picked up on a routine full blood count (or complete blood count). Occasionally, there may be bruising, particularly purpura in the forearms, petechia (pinpoint hemorrhages on skin and mucous membranes), nosebleeds, and/or bleeding gums.
   Eliciting a full medical history is vital to ensure the low platelet count is not due to a secondary process. It is also important to ensure that the other blood cell types, such as red blood cells and white blood cells, are not also suppressed. Painless, round and pinpoint (1 to 3 mm in diameter) petechia usually appear and fade, and sometimes group to form ecchymoses. Larger than petechia, ecchymoses are purple, blue or yellow-green bruises that vary in size and shape. They can occur anywhere on the body.
   
   
   Treatment 
                                                       
   Use of certain drugs may also lead to a low production of platelets in the bone marrow. The most common example is chemotherapy treatment.
   Thrombocytopenia usually improves when the underlying cause is treated. Sometimes medications, surgery or a blood or platelets  transfusion can help treat chronic thrombocytopenia.
   Corticosteroids may be used to increase platelet production. Lithium carbonate or Folate may also be used to stimulate the bone marrow production of platelets. Platelet transfusions may be used to stop episodic abnormal bleeding caused by a low platelet count. However, if platelet destruction results from an immune disorder, platelet infusions may have only a minimal effect and may be reserved for life-threatening bleeding.
   Specific treatment plans often depend on the underlying etiology of the thrombocytopenia.
   Exams and Tests
   Your health care provider will perform a physical exam and ask questions about your medical history and symptoms. The following tests may be done:
   
   Complete blood count (CBC) 
   Blood clotting studies (PTT and PT)
   Other tests that may help diagnose this condition include:
   
   Bone marrow aspiration or biopsy
   Platelet associated antibodies