Let's know about your platelet count? Variations and things to know

Have you ever seen a value called 'PLT' when you look at a Full Blood Count report? Or have you ever had a minor injury that causes a big bruise, or bleeding gums when brushing your teeth? All of these can be related to a small group of cells in your blood called platelets. They are also called thrombocytes. So, today we will talk about what these platelets are and what happens when they become too low.

So, what are these platelets?

Simply put, platelets are tiny cells in our blood that are produced in our bone marrow. Their main job is to stop bleeding when we get injured. Think about how your blood stops after a short while when you cut your arm. At that moment, these platelets come like heroes, come together to form a blood clot, and seal the wound. It's like a team of little mechanics rushing to fix a broken pipe.

How is Platelet Count measured?

Platelet count is measured with a routine blood test. This is measured in the Complete Blood Count (CBC) test that we routinely do. This can check the number of platelets in the blood along with the white blood cells and red blood cells.

Let's take a look at what the normal platelet count should be in the blood of a healthy person.

Let's talk about low platelets (Thrombocytopenia)

If your platelet count is less than 150,000, doctors call this condition thrombocytopenia. This is when you don't have enough platelets to stop bleeding after an injury.

What are the symptoms?

Sometimes, a small decrease in platelets may not cause any symptoms. However, when the number drops significantly, you may notice things like:

• Bruises easily: Even a slight bump can cause large blue/purple bruises.
• Bleeding that is difficult to stop: Bleeding gums when brushing your teeth, frequent nosebleeds, prolonged bleeding even from a small wound.
• Internal bleeding: Blood in the urine, blood in the stool (the stool may be black), blood in the vomit (may look like coffee grounds).
• Red spots on the skin: Very small, red flat spots (petechiae) caused by blood leaking from blood vessels under the skin.
• Purple spots on the skin: Large purple, red, brown-yellow spots (Purpura) caused by bleeding under the skin.
• Excessive fatigue and weakness.
• Heavy bleeding during menstruation in women.
• Spleen or liver swelling.

Why do platelets decrease?

There are three main reasons for low platelets:

1. The bone marrow does not produce enough platelets.

2. Rapid destruction or utilization of platelets by the body.

3. The spleen retains platelets and does not release them when needed.

These are some of the diseases and causes that can cause these conditions:

• Bone marrow diseases: Rare conditions like `Aplastic Anemia`, blood cancers like Leukemia or Lymphoma.
• Cancer treatments: Chemotherapy and radiation therapy can damage the bone marrow.
• Vitamin deficiencies: When vitamin B12 and folate are low, it becomes difficult for the bone marrow to make platelets.
• Autoimmune conditions: In diseases like Lupus and Rheumatoid Arthritis, the body's immune system mistakenly attacks and destroys its own platelets.
• Infections: Viral infections like HIV, Hepatitis C, and some bacterial infections.
• Certain medications: Some medications like Heparin and Quinine can cause platelet destruction.
• Diseases such as cirrhosis of the liver: These can cause the spleen to swell and platelets to become trapped in it.
• Excessive alcohol consumption.
• Some major surgeries: For example, heart surgery.

Let's also learn about increased platelets (Thrombocythemia/Thrombocytosis)

A platelet count above 450,000 is also a problem. This can lead to the formation of unwanted blood clots . These blood clots can get stuck in the blood vessels and cause dangerous conditions like heart attack, stroke, and pulmonary embolism.

There are two types of this condition:

• Primary Thrombocythemia: This is caused by an abnormal production of platelets in the bone marrow. This is usually caused by genetic changes.
• Secondary Thrombocytosis: This is the most common type of thrombocytosis, where the bone marrow is stimulated to produce more platelets due to another medical condition (e.g., infection, iron deficiency).

Symptoms are usually most noticeable in the primary stage. Examples include:

• Redness, burning, and numbness in the hands and feet.
• Chest pain.
• Headache, dizziness, weakness.
• Changes in vision.
• Bleeding (even though there are many platelets, sometimes they don't work properly).

What to do if platelets are low?

Treatment for low platelets depends on the cause and severity of symptoms. Your doctor will determine the best treatment.

• Treating the cause: If a medication is causing the low platelet count, that medication can be stopped and another can be given. If there is a deficiency in iron or vitamins, supplements can be given.
• Medications: Medications such as `Corticosteroids` (e.g. Prednisone) to increase platelet count, medications such as `Eltrombopag` and `Romiplostim` to increase platelet production in the bone marrow, and medications such as `Immunoglobulin` to stop the body from destroying platelets can be given.
• Blood or platelet transfusion: If there is bleeding or if the platelet level is very low, an external platelet transfusion may be performed.
• Splenectomy: If other treatments are not successful and the spleen is destroying platelets, your doctor may recommend surgical removal of the spleen .

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