Platelets are a type of blood cell. Platelets circulate the blood and clump together in response to damaged blood vessels. In binding together, they help form blood clots that slow or stop bleeding and help wounds to heal. 

Having too many or too few platelets can cause health complications. These conditions, known as platelet disorders, can occur on their own or in response to certain kinds of medications, treatments, or comorbidity. 

There are many different types of platelet disorders with various causes. Platelet disorders can be present at birth or can develop later in life depending on the person. 

Thrombocytopenia

Thrombocytopenia is one type of platelet disorder. People who have this condition have a low platelet count in the blood, which means the blood does not clot as easily. When platelet numbers drop below normal levels, it can result in increased bleeding and bruising. 

Causes and risk factors

Thrombocytopenia can arise from various causes, including immune system disorders. Conditions such as immune thrombocytopenia (ITP) and systemic lupus erythematosus (SLE) can lead to platelet destruction by the body's immune system.

Viruses like HIV, hepatitis C, and Epstein-Barr virus (EBV) can cause thrombocytopenia by affecting platelet production or increasing their destruction.

Certain drugs, such as chemotherapy agents, antibiotics, and anticonvulsants, may interfere with platelet production or function, resulting in thrombocytopenia.

Leukemia, myelodysplastic syndromes (MDS), and aplastic anemia can impair the production of platelets in the bone marrow.

Finally, rare genetic conditions like Wiskott-Aldrich syndrome and Bernard-Soulier syndrome can lead to low platelet counts.

Risk factors for thrombocytopenia include a family history of the condition, autoimmune disorders, exposure to certain medications, and previous chemotherapy or radiation therapy.

Symptoms and diagnosis

The following symptoms may indicate thrombocytopenia:

• Easy bruising or bleeding: Unexplained bruises, prolonged bleeding from cuts, nosebleeds, or excessive bleeding during menstruation can be signs of low platelet count.

• Petechiae: These are small, pinpoint-sized red or purple spots that appear on the skin due to bleeding under the surface.

• Excessive bleeding after dental procedures or surgery: People with thrombocytopenia may experience increased bleeding during and after invasive medical procedures.

• Blood in the urine or stools: Thrombocytopenia can lead to internal bleeding, which may manifest as blood in the urine or stools.

To diagnose thrombocytopenia, healthcare professionals may perform the following tests:

• Complete blood count: A blood sample is taken to measure the platelet count and assess the overall health of the blood.

• Peripheral blood smear: A microscope examination of a blood smear can help identify any abnormalities in the size, shape, or distribution of platelets.

• Bone marrow aspiration and biopsy: In some cases, a small sample of bone marrow may be taken to evaluate platelet production and identify any underlying disorders.

Treatment options and management strategies

The choice of treatment for thrombocytopenia depends on the underlying cause, severity of symptoms, and individual patient factors. 

Corticosteroids, immune globulin, and thrombopoietin receptor agonists can help increase platelet production or prevent their destruction in certain cases.

In severe cases or during active bleeding, transfusions of platelets or whole blood may be necessary to replenish platelet levels.

Addressing the primary cause of thrombocytopenia, such as treating infections, adjusting medications, or managing autoimmune disorders, can help improve platelet counts.

Individuals with thrombocytopenia should take precautions to minimize the risk of bleeding or injury. 

Close monitoring of platelet counts and regular check-ups with healthcare professionals are crucial to ensure effective management and timely adjustments to treatment plans.

Patient experiences with thrombocytopenia

On Inspire, members share their experiences dealing with low platelets and how their health teams managed their care:

“My understanding is that…chemo attacks the blood cells as well as the cancer, so low counts of red and white blood cells and platelets are common after chemo. I had my first chemo treatment (for my second recurrence) on May 4, but I had to miss the second on May 11 because of a low white blood cell count and on May 18 because of a low platelet count. I think the doctor will do something about it if my counts are still low next Wednesday, possibly a shot of neulasta or a blood transfusion.” Go to post

“I have cryptogenic cirrhosis-fancy word docs use to say they have no idea why I have cirrhosis. I have had decompensated cirrhosis for over two years. My spleen is enlarged. I was in hospital a bit over a week ago and my platelet count was 17. The docs kept doing lab work and as of the end of last week it was in the mid twenties. I mostly get a lot of bruising, some bleeding from gums. I did get a platelet infusion in January because they did an embolization on my liver and they didn’t want me to bleed out. Based on my conversations with multiple docs, they don’t start to worry until platelets are in the low teens, unless you are having symptoms. Prior to being diagnosed, I had liver biopsy, fibroscan. I also experienced fluid in my lung lining and hepatic encephalopathy with 2 weeks of each other. Everything added up to cirrhosis. I have experienced nausea, total body itch and pain (mostly from the peritonitis and an abdominal infection). Best of luck. Some days can be more difficult than others so adopt the one day at a time mindset.” Go to post

Thrombocythemia

Unlike thrombocytopenia, thrombocythemia is characterized by an abnormally high platelet count. When platelet numbers increase beyond normal levels, it can lead to various health complications.

Causes and risk factors

Thrombocythemia can have several underlying causes, including:

• Primary thrombocythemia: Also known as essential thrombocythemia, this condition arises from a genetic mutation in bone marrow cells, leading to the overproduction of platelets.

• Secondary thrombocythemia: High platelet counts can result from underlying conditions, such as chronic inflammation, iron deficiency, certain infections, or after the removal of the spleen.

• Reactive thrombocytosis: In response to specific factors like infection, trauma, surgery, or certain medications, the body may produce more platelets temporarily.

Risk factors for thrombocythemia include a family history of the condition, previous blood disorders, age, and certain genetic mutations.

Symptoms and diagnosis

Thrombocythemia may not always cause noticeable symptoms and is often diagnosed through routine blood tests. However, when symptoms do occur, they may include:

• Thrombosis or blood clots: Excessive platelets can increase the risk of blood clots, which can lead to deep vein thrombosis (DVT), stroke, or heart attack.

• Bleeding complications: Although counterintuitive, high platelet counts can cause abnormal bleeding, such as nosebleeds, bleeding gums, or prolonged menstrual bleeding.

• Headaches and dizziness: Increased blood viscosity due to high platelet counts can lead to headaches, dizziness, or lightheadedness.

• Vision or hearing changes: Rarely, thrombocythemia can affect blood flow to the eyes or ears, causing vision changes or hearing problems.

To diagnose thrombocythemia, healthcare professionals may perform a complete blood count. A blood sample is taken to measure platelet counts and assess other blood cell components. In some cases, a small sample of bone marrow is examined to evaluate the production and structure of blood cells. Finally, genetic mutations associated with thrombocythemia can be detected through specific genetic tests.

Treatment options and management strategies

The management of thrombocythemia depends on the underlying cause, the presence of symptoms, and the individual patient's risk factors. 

Certain medications, such as aspirin, can help prevent blood clot formation and reduce the risk of thrombotic events. Additionally, drugs that target the underlying cause, such as hydroxyurea or anagrelide, may be prescribed.

In cases where platelet counts are significantly high and the risk of thrombosis is elevated, a procedure called phlebotomy may be performed to remove a portion of blood and lower platelet levels.

Individuals with thrombocythemia should undergo regular blood tests and follow-up appointments to monitor platelet counts and assess the effectiveness of the chosen treatment.

Adopting a healthy lifestyle, including regular exercise, a balanced diet, and avoiding tobacco or excessive alcohol consumption, can help manage thrombocythemia.

Individuals with thrombocythemia can take steps to minimize the risk of blood clots, such as staying active during long periods of sitting, maintaining a healthy weight, and following any prescribed medications or preventive measures.

Patient experiences with thrombocythemia

On Inspire, members share their experiences dealing with high platelets and how their health teams managed their care:

“I went to a hematologist once a year for the past 5 years to try to find out why I’ve had these high platelets for so many years. Each year I have blood work from her, she is looking for blood cancer or disorders, everything is negative. She said she believes it’s reactive from Addison’s disease. I read on the internet that steroids can raise your platelet count, that’s the first I heard of it. I was just diagnosed with Primary Sjogrens and being watched for lupus since I have that antibody, like Addison’s isn’t enough to live with. Rheumatologist said high platelets mean inflammation.” Go to post

“My platelet counts were normal prior to [my cancer] diagnosis. Whenever I'm on chemo they get high. I think I'll ask to take an aspirin a day when on chemo…” Go to post

If you or a loved one have been diagnosed with a platelet disorder, you can learn more about the available treatments and management strategies to live a long, healthy life.

Disclaimer 

Member comments have been lightly edited for length and clarity. This content is for general informational purposes only and does not necessarily reflect the views and opinions of any organization or individual. The content should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider about any questions you may have regarding a medical condition.