Thrombocytopenia (reduced platelet count)

Thrombocytopenia is the term for a reduced platelet (thrombocyte) count. It occurs when platelets are lost from the circulation faster than they can be replaced from the bone marrow where they are made.

Thrombocytopenia may either result from a failure of platelet production and/or an increased rate of removal from blood.

Causes

Thrombocytopenia may be congenital or acquired; the acquired form is more common. In either case, it usually results from decreased or defective production of platelets in the marrow (for example, in leukemia, aplastic anemia, and toxicity with certain drugs) or from increased destruction outside the marrow caused by an underlying disorder (such as cirrhosis of the liver, disseminated intravascular coagulation, and severe infection).

Less commonly, thrombocytopenia results from sequestration (hypersplenism, hypothermia) or platelet loss. Acquired thrombocytopenia may result from the use of certain drugs, such as quinine, quinidine, rifampin, heparin, nonsteroidal anti-inflammatory agents, histamine blockers, most chemotherapeutic agents. allopurinol, and alcohol.

Thrombocytopenia may also occur transiently after a viral infection (such as Epstein-Barr) or infectious mononucleosis. An idiopathic form of thrombo­cytopenia also occurs.

Symptoms

The following are the most common symptoms of thrombocytopenia. However, each baby may experience symptoms differently. Symptoms may include:

• bruising or petechiae (small red spots on the skin)
• signs of bleeding in other body systems
• jaundice

The symptoms of thrombocytopenia may resemble other conditions or medical problems. Always consult your baby's physician for a diagnosis.

Diagnostic tests

• CBC shows low platelets
• Bone marrow aspiration or biopsy may be normal or may show low megakaryocytes (platelet precursors) or an infiltrating disease.
• PTT clotting study is normal
• PT clotting study is normal
• Platelet associated antibodies may be present

Treatment

Removal of the offending agents in drug-induced thrombocytopenia or proper treatment of the underlying cause, when possible, is essential. Corticosteroids may be used to increase platelet production or immune globulin.

Platelet transfusions may be used to stop episodic abnormal bleeding caused by a low platelet count. If platelet destruction results from an immune disorder, platelet infusions may have only a minimal effect and may be reserved for life-threatening bleeding.

Splenectomy may be necessary to correct thrombocytopenia caused by platelet destruction. A splenectomy should significantly reduce platelet destruction because the spleen acts as the primary site of platelet removal and antibody production.

Prevention

Prevention depends on the specific cause.

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