Causes and risk factors
Thrombocytopenia occurs due to one of the three reasons – failure of megakaryocytic maturation hence platelet formation, excessive platelet consumption after their release into circulation, platelet sequestration in an enlarged spleen. Causes of thrombocytopenia include marrow disorders like drug induced hypoplasia, infiltration of leukaemia, myeloma, carcinoma, myelofirbrosis, osteopetrosis; vitamin B12 or folate deficiency. Increased consumption of platelets such as in disseminated intravascular coagulation [DIC], idiopathic thrombocytopenic purpura, viral infections like Epstein barr virus, HIV, bacterial infections like septicaemia, liver disease, connective tissue disease like SLE.
Clinical presentation
Purpura [purplish discolouration of skin which measures from 3 to 10 mm] and spontaneous bleeding are characteristic of thrombocytopenia; it may be oral, nasal, gastrointestinal, or genitourinary bleeding. Bleeding is seen only when count goes abnormally low especially below 30 x 109 /L
Investigation
Medical history by the patient and Clinical examination by the doctor helps in diagnosis. Routine haemogram reveals thrombocytopenia. Further investigations depend on the possible causes. Blood film may help in diagnosis e.g. acute leukaemia. Examination of bone marrow is done for diagnosis of infiltration of carcinoma.
Treatment
Treating the underlying cause is required in thrombocytopenia. Idiopathic thrombocytopenia requires no treatment and resolves itself. Correcting the deficiency i.e. vitamin B12 or folate supplements may be advised. Steroids help in treatment of thrombocytopenic purpura. In severe cases intravenous immunoglobulin, plasma or platelet transfusion is recommended. In non responding cases spleenectomy is done.
Other Modes of treatment
The other modes of treatment can also be effective in treating thrombocytopenia. Homoeopathy is a science which deals with individualization considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating thrombocytopenia.
Recent updates
The idiopathic thrombocytopenia is now named as immune thrombocytopenia [ITP]. Sophisticated immunological and molecular techniques have facilitated a better understanding of pathophysiology at cellular and humoral levels.
