What do the numbers mean?
Anxiety after analysis is almost always associated with the fact that a person sees a figure below the normal limit and does not understand the scale of the deviation. There is a very long distance between “slightly below normal” and “dangerously low”, and the guidelines here are quite clear.
- The norm is approximately 150–400 thousand per microliter
- 100–150 thousand: usually does not manifest itself in any way, but requires observation and search for the cause
- 50–100 thousand: bleeding is possible with injuries and interventions, in ordinary life, as a rule, not
- 20–50 thousand: bruises, bleeding gums, heavy periods, prolonged bleeding from cuts
- Below 20 thousand: risk of spontaneous bleeding, urgent assessment by a hematologist is needed
Dynamics are no less important. An indicator that has remained at the same level for months and an indicator that has halved in two weeks require a completely different attitude, even if the figure is the same at the moment. Therefore, old tests are not unnecessary rubbish: if you have results from one or two years ago, you should take them with you to your appointment, they save examination and time.
False thrombocytopenia: analysis of a common mistake
Blood for general analysis is drawn into a test tube with an anticoagulant. In some people, platelets in the presence of this substance stick together into clumps, and the automatic counter stops counting them as individual cells. The result is “40 thousand platelets” in a completely healthy person without a single bruise.
- A sign that is alarming: a very low rate with no bleeding at all
- The check is simple - repeated analysis and mandatory examination of the blood smear by a laboratory doctor
- If adhesion is confirmed, the blood is transferred to a test tube with another anticoagulant.
- Sometimes it is enough to test the blood from a finger or deliver the test tube to the laboratory faster than usual
- This feature persists in a person for life, and it is useful to remember it at each subsequent analysis.
- This finding does not require treatment: this is a feature of the laboratory test, not a disease
Before starting an examination for low platelets, this option is always excluded. It occurs much more often than is commonly thought, and checking it eliminates unnecessary tests, consultations and anxiety.
Why platelets become low
There are only three mechanisms: cells are destroyed faster than they are formed; the bone marrow does not produce them enough; platelets are retained in the enlarged spleen. There are many reasons that trigger these mechanisms.
- Immune thrombocytopenia - the body produces antibodies to its own platelets; a common cause in children after a viral infection and in adults
- Viral infections: influenza, infectious mononucleosis, hepatitis B and C, HIV, mosquito-borne infections
- Medicines: selected antibiotics, anticonvulsants, heparin, gout medications, painkillers
- Liver disease and cirrhosis: an enlarged spleen retains platelets, and the liver is less able to produce a substance that stimulates platelet production
- Vitamin B12 and folic acid deficiency
- Autoimmune diseases: systemic lupus erythematosus, antiphospholipid syndrome, thyroid pathology
- Bone marrow diseases: leukemia, myelodysplastic syndrome, aplastic anemia, tumor metastases
- Pregnancy: Gestational thrombocytopenia is the most common and usually harmless form
- Alcohol abuse
- Rare but dangerous conditions: thrombotic microangiopathy, disseminated intravascular coagulation syndrome
- Hereditary thrombocytopenias are rare but present from birth and are usually accompanied by a family history of bruising
- Massive transfusion of solutions and blood components during injury or surgery
- Copper deficiency and severe nutritional disorders
A separate assessment is made of whether this decrease is isolated. If platelets are low, and erythrocytes and leukocytes are normal, there is one range of reasons and it is mostly favorable. If all three blood lines are reduced at once, we are talking about a problem with the bone marrow itself, and this situation requires a faster and more in-depth examination. That is why the doctor looks not at one line on the form, but at the entire analysis.
Survey
There is no universal list of platelet tests: the scope of the examination is determined by how pronounced the decrease is, whether there is bleeding, and what was found during the examination. But the basic set, which they almost always start with, looks like this.
- Повторный общий анализ крови с обязательным просмотром мазка: исключение ложного результата и оценка остальных ростков крови.
- Коагулограмма: при изолированной тромбоцитопении свёртывание обычно не нарушено, и это помогает отличить её от других причин кровоточивости.
- Биохимия, показатели работы печени, УЗИ печени и селезёнки.
- Анализы на ВИЧ, гепатиты B и C — обязательный минимум, потому что эти инфекции нередко дебютируют именно снижением тромбоцитов.
- Ферритин, витамин B12, фолиевая кислота, гормоны щитовидной железы.
- Тесты на аутоиммунные заболевания при соответствующих признаках.
- Исследование костного мозга — не всем, а при снижении и других клеток крови, необычной картине мазка, возрасте старше 60 лет или отсутствии эффекта от лечения.
- Подсчёт молодых тромбоцитов: он показывает, работает ли костный мозг, или проблема в разрушении уже готовых клеток.
- Обязательный опрос о кровоточивости у родственников: наследственные формы редки, но их пропускают чаще всего именно потому, что об этом не спрашивают.
The diagnosis of immune thrombocytopenia is made by exclusion: there is no special analysis that would directly confirm it. This often causes confusion among patients who are waiting for one crucial test. In fact, the doctor consistently cuts off infections, medications, liver disease, deficiencies and autoimmune diseases, and when none of these are confirmed, and only platelets are low, the diagnosis becomes obvious.
Treatment
They treat not the number, but the cause and risk of bleeding. A person with a level of 90 thousand without complaints is often simply observed, and with a pronounced decrease with bleeding they act quickly and usually in a hospital.
- Discontinuation of the drug that caused the decrease
- Treatment of infection or underlying disease of the liver, thyroid gland, connective tissue
- Replenishment of vitamin B12 and folic acid deficiency, if identified
- For immune thrombocytopenia - hormonal therapy, intravenous immunoglobulin if a quick effect is needed, drugs that stimulate platelet production, in some cases, removal of the spleen
- Platelet transfusion - only in case of threatening bleeding or before intervention, and not in order to “raise the analysis”
- Medicines that reduce bleeding of mucous membranes - for nosebleeds and menstrual bleeding, as prescribed by a doctor
- With Helicobacter pylori infection, in some patients, its treatment itself leads to an increase in platelets
A separate task is preparation for operations and dental procedures. The surgeon and dentist are warned about low platelet levels in advance, before the intervention, and not after bleeding has begun.
Rules for living with low platelets
These recommendations are relevant in case of a noticeable decrease and for the time until the indicator has recovered. With moderate thrombocytopenia without bleeding, there is usually no need to change your lifestyle, and there is no point in prohibiting yourself from everything.
- Do not take aspirin, ibuprofen and other anti-inflammatory painkillers without your doctor's permission - they further interfere with platelet function
- Discuss any blood thinning medications with your doctor
- Avoid contact sports and situations with risk of hitting your head
- Use a soft toothbrush, shave carefully, avoid toothpicks
- Postpone tattoos, piercings and cosmetic procedures with skin punctures until the indicator normalizes
- Keep the results of the latest tests at home so that the doctor can see the dynamics at any time, and not just one number
- Do not give intramuscular injections unless necessary
- Limit alcohol: it inhibits platelet production in the bone marrow
- Avoid constipation: straining increases the risk of hemorrhages, including in the retina
- Be careful with herbal supplements and “blood thinning” tinctures - some of them affect platelets
- Carry information about the diagnosis with you - it may be needed in case of injury or emergency surgery
- If you have a nosebleed, press the wing of your nose and tilt your head forward, rather than tilting it back.
- Communicate diagnosis before any injection, catheter placement or dental appointment
For women with low platelets, the menstrual cycle is discussed separately: heavy bleeding with thrombocytopenia quickly leads to iron deficiency anemia, and then another problem is added to one. This can be solved, and is decided jointly by the hematologist and gynecologist, so it is imperative to mention heavy periods at the appointment, even if the question about this was not raised.