Thrombocytopenia is current conditionnumber of blood platelets (platelets)low, below normal value. TPlatelets play a role in stopping bleeding when there is injury or damage to blood vessels. A low platelet count can make it difficult for blood to clot.
The normal number of platelets in the blood is 150,000-450,000 cells per microliter of blood. If the platelet count is less than 150,000, then a person can be considered to have thrombocytopenia. A person suffering from thrombocytopenia is prone to bleeding, such as easy bruising, nosebleeds, or frequent bleeding gums.
Thrombocytopenia can be caused by several conditions, such as dengue fever, ITP, aplastic anemia, and leukemia; or as a side effect of radiotherapy and chemotherapy. If the platelet count does not fall too low or is still above 50,000, generally there is no need for special treatment to increase the platelet count.
Symptoms of Thrombocytopenia
Mild thrombocytopenia generally causes no symptoms. This condition is usually only discovered when the patient performs a blood cell count for other purposes.
If the number of platelets decreases, the patient will feel the main symptom in the form of bleeding, both visible from the outside and internal organ bleeding. Internal organ bleeding is more difficult to detect and symptoms vary depending on the organ that is bleeding.
While bleeding on the outside of the body appears as bruising or bruising, and bleeding that is difficult to stop. Other bleeding symptoms that can occur due to thrombocytopenia are:
- Nosebleed
- Bleeding gums
- Menstruation more than usual
- Hematuria
- Bloody or black stools
- Vomiting blood or color like coffee
When to go to the doctor
Call your doctor immediately if you experience bleeding without being preceded by an injury, especially if the bleeding doesn't stop. Bleeding that does not stop can cause shock which can be fatal. Watch out for symptoms of shock, such as dark vision, palpitations, and cold sweats.
If you suffer from a chronic disease that causes your platelet count to drop, such as ITP or aplastic anemia, have regular check-ups with your doctor. People with thrombocytopenia need to be alert if they feel severe headaches or nervous disorders, because these symptoms may indicate bleeding in the brain.
Reason Platelets Down
Thrombocytopenia can be transient or prolonged. There is no definite time limit on the two, but what is clear, relates to the cause.
The following will describe the causes of temporary (acute) declines in platelets and the causes of prolonged (chronic) declines in platelets:
Causes of a temporary drop in platelets
Causes of acute thrombocytopenia vary, but the most commonly known is dengue hemorrhagic fever (DHF). Not only DHF, other viral infections, such as HIV or hepatitis, also cause platelets to drop. Apart from a viral infection, other causes of a temporary drop in platelets are:
- Preeclampsia and HELLP syndrome during pregnancy.
- Acute leukemia.
- Side effects of chemotherapy drugs, heparin, quinine pills, and sulfonamide antibiotics.
- Side effects of radiotherapy.
- Hemolytic uremic syndrome.
Causes of prolonged decline in platelets
Chronic thrombocytopenia is generally caused by: idiopathic thrombocytopenic purpura (ITP). ITP is thought to occur due to the immune system mistakenly attacking and destroying platelets, resulting in reduced numbers.
In addition to ITP, prolonged (chronic) thrombocytopenia can also be caused by:
- Long term alcohol addiction.
- Liver disease.
- Myelodysplastic syndrome.
- Aplastic anemia disease.
- Myelofibrosis disease.
- Genetic disorders, such as Wiskott-Aldrich Syndrome.
- Thrombotic thrombocytopenic purpura.
Diagnosis of Thrombocytopenia
At the initial stage of the examination, the doctor will ask about the patient's symptoms and medical history. The doctor will also perform a physical examination to determine the presence of bruising or red spots on the skin, which is one of the symptoms of thrombocytopenia.
If the patient is suspected of having thrombocytopenia, the doctor will order a blood test. Blood tests performed were complete blood count and peripheral blood smear examination. Through these two examinations, the doctor will determine the number of platelets in the blood, as well as the structure and condition of the blood cells under a microscope.
Blood tests can also be done to detect the cause of thrombocytopenia, such as liver function tests to look for liver disease. In addition to blood tests, the doctor may also perform several follow-up examinations, such as:
- abdominal ultrasound
Abdominal ultrasound is done to determine whether there is enlargement of the liver or spleen.
- AspirationBone marrowBone marrow aspiration examination is done to see the number and structure of blood cells directly from the manufacturer, namely the bone marrow. This examination also looks at the condition of the bone marrow, by taking a small sample of tissue (bone marrow biopsy).
Method Raise Platelet Count
Not all decreased platelet counts need to be treated. Before planning treatment for thrombocytopenia, doctors need to find out the cause and find out how many platelets are in the blood. Both of these determine the severity of thrombocytopenia experienced by the patient.
Mild thrombocytopenia (platelet count still above 50,000 cells per microliter of blood) tends to cause no symptoms. There is no specific treatment to raise the platelet count.
Doctors will only provide treatment to treat the cause of the decrease in the number of platelets and to prevent the number from getting lower. If the cause of decreased platelets is a prolonged (chronic) disease, the patient needs to undergo regular check-ups with a doctor to monitor the course of the disease.
To prevent bleeding, the doctor will advise the patient to:
- Avoid activities that pose a risk of injury, such as soccer.
- Be careful when taking over-the-counter pain relievers, and use the drug according to the directions for use.
- Reduce alcohol consumption.
Treatment for thrombocytopenia varies depending on the cause, platelet count, and the acute or chronic course of the disease. Here's the explanation:
- If the thrombocytopenia is caused by a side effect of the drug, the doctor will replace or stop using the drug if necessary.
- If the thrombocytopenia is caused by a viral infection, the doctor will prescribe antiviral drugs if needed. Some viral infections, such as dengue fever, do not require antiviral drugs, but only require adequate fluid intake.
- If the thrombocytopenia is caused by long-term alcohol addiction, the doctor will ask the patient to stop drinking alcohol.
- If the thrombocytopenia is caused by an autoimmune disease, such as ITP, the treatment is corticosteroids.
Serious bleeding, such as a brain hemorrhage, is at risk for a platelet count of less than 10,000-20,000 cells per microliter of blood. Therefore, if the platelet count is too low or treatment to treat the cause does not give satisfactory results, the doctor will increase the platelet count in the following ways:
- Platelet transfusion
- The drug eltrombopag
- Plasmapheresis action
- Spleen removal surgery
Complications of Thrombocytopenia
Complications that can occur due to thrombocytopenia are heavy bleeding in the brain or digestive tract. Bleeding in the brain and digestive tract is a condition that must be treated immediately. If symptoms appear in the form of severe headaches or bloody stools, contact your doctor immediately.
Prevention of Thrombocytopenia
The main preventive measure of thrombocytopenia is to avoid the cause of the decline in platelets. Things to do are:
- Avoid drinking alcoholic beverages.
- Get vaccinated to prevent some viral infections that can lower your platelet count, such as chickenpox and rubella.
- Participate in the mosquito nest eradication program to prevent dengue fever.
In addition to preventing the cause, people with thrombocytopenia need to prevent bleeding due to thrombocytopenia, among others by using a soft toothbrush so that the gums don't bleed and avoiding activities that can cause injury, such as playing soccer.