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General Practice 2023

Low platelets: symptoms, what it can be (and what to do)

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Low platelets: symptoms, what it can be (and what to do)
Low platelets: symptoms, what it can be (and what to do)

Low platelet can happen due to infections, use of drugs, such as heparin, or be a consequence of immunity-related diseases, such as thrombocytopenic purpura and cancer, for example. Platelets are essential components of blood for clotting, facilitating wound healing and preventing bleeding.

In this way, the decrease in the amount of platelets, known as thrombocytopenia or thrombocytopenia, can interfere with blood clotting and lead to the appearance of some symptoms such as purple or red spots on the skin, bleeding in the gums or through the nose and reddish urine. See more about platelets.

In the presence of symptoms indicative of platelet alterations, it is important that the hematologist or general practitioner be consulted so that the cause can be identified and the most appropriate treatment initiated, which may involve the use of medication or, in more severe cases, severe, platelet transfusion.


Symptoms of low platelets

Platelets are low when the blood count is less than 150,000 cells/mm³ of blood, and most of the time they do not cause symptoms. However, the person may be more prone to bleeding, and symptoms such as:

  • Purple or red spots on the skin, such as bruises or bruises;
  • Bleeding gums;
  • Nosebleed;
  • Blood urine;
  • Bleeding in stool;
  • Large menstruation;
  • Bleeding wounds that are difficult to control.

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

Main causes

Platelets are produced in the bone marrow, and they live about 10 days, as they are always being renewed. Factors that affect the number of blood platelets are:

1. Destruction of platelets

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

  • Virus infections, such as dengue, Zika, mononucleosis and HIV, for example, or bacteria, which affect platelet survival due to changes in the person's immunity;
  • Use of some medications, such as Heparin, Sulfa, anti-inflammatory, anticonvulsant 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 medication and infections. In addition, each person can have a different reaction, which varies according to the immunity and the body's 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 such as 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 monitoring, malnourished people, alcoholics and people with diseases that cause hidden bleeding, such as gastric or intestinal bleeding.

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

3. Bone marrow changes

Some alterations in the functioning of the marrow cause the production of platelets to be reduced, which can happen for several reasons, such as:

  • Diseases of the bone marrow, such as aplastic anemia or myelodysplasia, for example, which cause decreased or erroneous 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 bone marrow, 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.

4. Problems with 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 a elimination of platelets still he althy, 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 error in the laboratory result, as platelet aggregation can occur in the blood collection tube, due to the presence of a reagent in the tube, being important to repeat the exam in these cases.

Alcoholism can also cause platelet reduction, as alcohol consumption, in addition to being toxic to blood cells, also affects bone marrow production. In pregnancy, physiological thrombocytopenia may occur, due to blood dilution by fluid retention, which is usually mild and resolves spontaneously after delivery.

In addition, cases of decreased platelets due to COVID-19 and/or as an adverse effect of the adenovirus-containing vaccine, mainly AstraZeneca and Johnson & Johnson, have been reported, being in these cases associated with thrombosis. However, these adverse effects due to the vaccine are rare.

How to increase platelets

After identifying the cause of low platelets, the doctor may indicate the best treatment to increase the number of platelets, which may involve:

  • Removing the cause, such as medication, treating illnesses and infections, or reducing 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 plasmapheresis, is a kind of filtration of a part of the blood that contains antibodies and components that are impairing the functioning of the immunity and of blood circulation, indicated in diseases such as thrombotic thrombocytopenic, hemolytic-uremic syndrome, for example;
  • Platelet transfusion, which is mainly indicated when there is bleeding, when surgery is needed or when platelets are below 20,000 cells/mm³ of blood.

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

In addition, it is important to maintain a balanced diet, rich in cereals, fruits, vegetables and lean meats, to help with blood formation and body recovery. It is also recommended to avoid strenuous efforts or contact sports, avoid alcohol consumption and not use drugs that affect platelet function or increase the risk of bleeding, such as aspirin, anti-inflammatories, anticoagulants and ginkgo-biloba, for example..

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