Main causes and what to do when platelets are low

Thrombocytopenia, or thrombocytopenia, corresponds to the decrease in the number of platelets in the blood, a situation that impairs clotting, and can cause symptoms such as red or red spots on the skin, bleeding gums or nose, and red urine, for example.

Platelets are essential components of the blood for clotting, facilitating wound healing and preventing bleeding. However, there are several situations that can cause a decrease in the amount of platelets, such as infections, such as dengue, use of drugs, such as heparin, immunity-related diseases, such as thrombocytopenic purpura and even cancer.

The treatment of low platelets should be done according to their cause, by the general practitioner or hematologist, and may only be necessary to control the cause, use of medicines or, in very severe cases, the transfusion of platelets.

See other major platelet changes and what to do.

Main symptoms

Platelets are low when the blood count is less than 150, 000 cells / mm³ of blood, and, most of the time, cause no symptoms. However, the person may have a greater tendency to bleed, and symptoms such as:

• Purple or reddish spots on the skin, such as bruises or bruises; Bleeding gums; Bleeding through the nose; Urine with blood; Bleeding in stools; Bulky menstruation; Wounds with bleeding that are difficult to control.

These symptoms can appear in anyone with low platelets, but they are more common when they are very low, such as below 50, 000 cells / mm³ of blood, or when associated with another disease, such as dengue or cirrhosis, which worsen the clotting function of the blood.

One of the diseases most commonly associated with platelet reduction is thrombocytopenic purpura. See what this disease is and how to treat it.

What can it be

Platelets are produced in the bone marrow, and live for about 10 days, as they are always renewing themselves. The factors that interfere with the number of platelets in the blood are:

1. Destruction of Platelets

Some situations can cause platelets to live in the bloodstream for less time, which causes their number to decrease. Some of the main causes are:

• Infections by viruses, such as dengue, Zika, mononucleosis and HIV, for example, or by bacteria, which affect the survival of platelets due to changes in the person's immunity; Use of some medicines, such as Heparin, Sulfa, anti-inflammatory, anti-convulsant and antihypertensive drugs, for example, as they can cause reactions that destroy platelets; Autoimmune diseases, which can develop reactions that attack and eliminate platelets, such as lupus, immune and thrombotic thrombocytopenic purpura, hemolytic-uremic syndrome and hypothyroidism, for example.

Immunity diseases tend to cause a more severe and persistent reduction in platelets than the use of medicine and infections. In addition, each person may have a different reaction, which varies according to the body's immunity and response, so it is common to see people with lower platelets in some cases of dengue than in others, for example.

2. Lack of folic acid or vitamin B12

Substances like folic acid and vitamin B12 are essential for hematopoiesis, which is the process of blood cell formation. However, a lack of folic acid or vitamin B12 can lead to decreased production of red blood cells, white blood cells and platelets. These deficiencies are common in vegans without nutritional support, malnourished people, alcoholics and people with diseases that cause hidden bleeding, such as gastric or intestinal.

Here are some tips on what to eat to avoid deficiency of folic acid and vitamin B12.

3. Changes in bone marrow

Some changes in the functioning of the spinal cord cause the production of platelets to decrease, which can happen for several reasons, such as:

• Bone marrow diseases, such as aplastic anemia or myelodysplasia, for example, which cause decreased production or wrong production of blood cells; Bone marrow infections, such as HIV, Epstein-Barr virus and chickenpox; Cancer that affects the bone marrow, such as leukemia, lymphoma or metastases, for example; Chemotherapy, radiation therapy or exposure to substances toxic to the spinal cord, such as lead and aluminum;

It is common that, in these cases, there is also the presence of anemia and a decrease in white blood cells in the blood test, as the bone marrow is responsible for the production of several blood components. Check what are the symptoms of leukemia and when to suspect.

4. Problems in the functioning of the spleen

The spleen is responsible for eliminating several old blood cells, including platelets, and, if it is enlarged, as in cases of diseases such as liver cirrhosis, sarcoidosis and amyloidosis, for example, there may be an elimination of still healthy platelets, in an amount above normal.

5. Other causes

In the presence of low platelets without a defined cause, it is important to think about some situations, such as the laboratory result error, as platelets may aggregate in the blood collection tube, due to the presence of a reagent in the tube, and it is important to repeat the exam in these cases.

Alcoholism can also cause a reduction in platelets, as alcohol consumption, in addition to being toxic to blood cells, also affects production by the bone marrow.

In pregnancy, physiological thrombocytopenia may occur, due to blood dilution due to fluid retention, which is usually mild, and resolves spontaneously after delivery.

What to do in case of low platelets

In the presence of a thrombocytopenia detected in the test, it is important to take some precautions to avoid the risk of bleeding, such as avoiding intense efforts or contact sports, avoiding alcohol consumption and not using drugs that affect platelet function or increase the risk bleeding, such as aspirin, anti-inflammatories, anticoagulants and ginkgo-biloba, for example.

Care must be reinforced when platelets are below 50, 000 cells / mm³ in the blood, and it is worrying when below 20, 000 cells / mm³ in the blood, hospitalization for observation may be necessary in some cases.

The diet must be well balanced, rich in cereals, fruits, vegetables and lean meats, to assist in the formation of blood and the recovery of the organism.

Platelet transfusion is not always necessary, because with care and treatment, the person can recover or live well. However, the doctor can give other guidelines when there are bleeding situations, when it is necessary to perform some type of surgery, when the platelets are below 10, 000 cells / mm³ in the blood or when they are below 20, 000 cells / mm³ in the blood, but also when fever or need for chemotherapy, for example.

How the treatment is done

After determining the reason why the platelets are low, your treatment will be directed, according to medical advice, and can be:

• Removal of the cause, such as medicines, treatment of diseases and infections, or reduction of alcohol consumption, which trigger low platelets; Use of corticosteroids, steroids or immunosuppressants, when it is necessary to treat an autoimmune disease; Surgical removal of the spleen, which is splenectomy, when thrombocytopenia is severe and caused by increased spleen function; Blood filtration, called plasma exchange or plasma exchange, is a kind of filtration of a part of the blood that contains antibodies and components that are impairing the functioning of immunity and blood circulation, indicated in diseases such as thrombotic thrombocytopenic, hemolytic-uremic syndrome, for example.

In the case of cancer, treatment is made for the type and severity of this disease, with chemotherapy or bone marrow transplantation for example.