Platelet Disorders

What are platelet disorders?

Platelet disorders are conditions that impact how many platelets you have or how they work. Platelets are cells that bind together to form clots if you’re injured. They’re like your body’s natural bandage that stops bleeding. But platelet disorders can cause issues with platelet function.

Types of platelet disorders

There are three main types of platelet disorders:

• Thrombocytosis. You have too many platelets in your blood.
• Thrombocytopenia. You have too few platelets in your blood.
• Platelet dysfunction. You have a normal amount of platelets, but they don’t work as expected.

Most platelet disorders cause mild symptoms or no symptoms at all. But in some cases, they can increase your bleeding risk. This is especially the case with low platelets and platelet dysfunction. They can occasionally increase your risk of dangerous clots, especially if your platelet counts are high.

A healthcare provider can explain potential risks and recommend treatments based on your situation.

What are the symptoms of platelet disorders?

Symptoms of platelet disorders include:

• Signs of bleeding beneath your skin (like bruises, also known as purpura, and pinpoint-sized spots called petechiae)
• Heavy periods or nosebleeds
• Bleeding gums
• Blood in your poop or pee
• Feeling weak, dizzy or lightheaded
• Abnormal blood clots

What causes platelet disorders?

Platelet disorder causes vary. Sometimes, they result from an underlying condition or a medication you’re taking. Other times, they happen because of a condition you inherit from a biological parent.

High platelets

High platelets can occasionally happen if you have a mutation in certain genes that causes your body to overproduce platelets. This is called essential thrombocythemia. More commonly, your body makes too many platelets in response to something else. This is called reactive thrombocytosis. Causes include:

• Iron-deficiency anemia
• Inflammatory conditions (including cancer and infections)
• Injuries
• Certain medications

Low platelets

Your platelets may be low because your body just isn’t making enough of them. Low counts can happen when a condition destroys platelets or your spleen traps too many. Usually, your spleen stores about one-third of your platelets. Causes include:

• Autoimmune diseases, including immune thrombocytopenia
• Blood cancers (where your bone marrow becomes filled with malignant cells)
• Blood disorders, including thrombotic thrombocytopenic purpura (TPP)
• Disseminated intravascular coagulation (DIC)
• Infections
• Treatments, including certain medicines and cancer therapies

Platelet dysfunction

Some conditions and medications can impact platelet function even if your levels are normal. Platelet dysfunction can result from conditions you’re born with (inherited) and those that you develop (acquire) later in life:

• Inherited conditions. Bernard Soulier syndrome, Glanzman thrombasthenia, Von Willebrand disease, and Wiskott-Aldrich syndrome are rare disorders that cause platelet dysfunction.
• Acquired conditions. Kidney failure, liver disease and lupus are just a few examples of conditions that can cause issues with how your platelets work.
• Medications. SSRI antidepressants or NSAIDs, like aspirin, are the most common causes of platelet dysfunction.

Risk factors of platelet disorders

Several factors can increase your risk of a platelet disorder, including:

• Age. You may be at increased risk of a specific type of platelet disorder depending on your age.
• Sex. Platelet disorders can affect anyone, but symptoms are most common in women due to menstruation and other causes of bleeding, like childbirth.
• Family history. Some inherited platelet disorders can be transmitted to offspring.
• Medical conditions. Problems with platelets can result from autoimmune diseases, infections, kidney and liver disease, cancer and many other conditions.
• Cancer treatments. Chemotherapy and radiation therapy can lower your platelet count.
• Medications. Antibiotics and antiseizure medicines are a couple of the medication types that can impact your platelets.
• Lifestyle. Drinking a lot of alcohol and using tobacco products can affect platelet production.

What are the complications of this condition?

Complications of platelet disorders include:

• Hemorrhage
• Heavy menstrual periods (menorrhagia)
• Gastrointestinal bleeding
• Deep vein thrombosis or pulmonary embolism (in essential thrombocytosis)
• Heart attack

Working with a healthcare provider to find the right treatment plan can often prevent complications from happening.

How are platelet disorders diagnosed?

A healthcare provider will do a physical exam to check for signs of a platelet disorder. They’ll ask about your symptoms and medical history, including which medicines you’re taking. They’ll do blood tests to check your platelets. Tests include:

• Complete blood count (CBC). This blood test includes a platelet count. It counts how many platelets are in your blood.
• Peripheral blood smear (PBS). During this test, a provider views your platelets beneath a microscope to see if they look normal.
• Platelet function tests. These tests show how effectively your platelets form clots.

You may need more tests to determine what’s causing a platelet disorder. Your provider may order a:

• Bone marrow biopsy. This test checks for abnormal cells (signs of a blood disorder or cancer).
• Genetic test. This test detects variants associated with genetic conditions that cause platelet disorders.

How are platelet disorders treated?

Treatment for platelet disorders depends on what’s causing it. For chronic platelet disorders, you need to work with a hematologist (blood specialist) to make sure your platelets are at safe levels.

Treatments include:

• Watchful waiting. If your symptoms are mild, you may not need treatment. Instead, your provider may monitor your platelets by doing regular blood tests.
• Medications. If your platelet count is excessively high due to essential thrombocytosis or another blood cancer, such as myeloproliferative disease, you may need medication to lower your platelet count.
• Platelet depletion. Very rarely, you may need a type of apheresis to remove excess platelets from your blood.
• Platelet transfusion. You may need a platelet transfusion if your platelet counts are severely low.
• Plasma therapy. You may need a plasma exchange if you have a disease called TTP. The goal of this treatment is to replace a missing part of your blood called ADAMTS13.

What can I expect if I have this condition?

Your experience depends on the type of platelet disorder you have and what’s causing it. Often, platelet counts return to normal once you get treated for the condition causing it. Or your condition may not pose risks unless you’re hurt. In that case, you may need to take steps to reduce your chances of injury. Your care team may need to take extra care to prevent bleeding during surgeries.

With more serious conditions, you may need to take medications regularly. You may need routine treatments and tests to ensure you have the correct number of healthy platelets.

How do I take care of myself?

The best thing you can do if you’re living with a platelet disorder is to understand how to reduce your risk of bleeding or dangerous clots. It’s important to know:

• Which activities to avoid. Some platelet disorders increase your risk of severe bleeding if you’re injured. You may need to avoid activities (like contact sports) where injuries are common.
• How to tend a wound. Knowing how to apply pressure to a wound to stop bleeding is important if you’re at risk of blood loss. Your healthcare provider can teach you.
• Which medications to take (and avoid). You may need to take medications regularly to manage a platelet disorder. You may need to steer clear of medicines that can inhibit platelet function and increase your bleeding risk.
• Which supplements to avoid. Some supplements can increase your bleeding risk if you have a platelet disorder. Ask your healthcare provider which ones to avoid.
• How to communicate with your providers. Your healthcare providers need to know if you’re planning a procedure associated with bleeding, such as oral or other surgery.

Ask your hematologist or the provider who’s managing your condition to advise you on these things.

When should I see my healthcare provider?

See a healthcare provider if you’re noticing signs of a platelet disorder, like excessive and persistent bruising. Take note of bruises larger than a half dollar that you do not recall getting, like from an injury.

Seek emergency care if you’re experiencing signs of severe blood loss or a blood clot (like a stroke or heart attack).

What questions should I ask my healthcare provider?

Questions to ask include:

• How serious is my condition?
• Is it curable?
• What treatments will help?
• How often will you need to check my platelets?
• What can I do to prevent harmful bleeding or blood clots?