Can Low Platelet Count Cause Fatigue

Immune Thrombocytopenia: The Patients Perspective

Caroline Kruse1, Alexandra Kruse1,2, Jennifer DiRaimo1

1 Tulane University School of Medicine , , USA

Contributions: Conception and design: All authors Provision of study materials or patients: All authors Collection and assembly of data: All authors Data analysis and interpretation: All authors Manuscript writing: All authors Final approval of manuscript: All authors.

Correspondence to:

Keywords: Immune thrombocytopenia quality of life patient perspectives platelet disorders

Received: 21 September 2020 Accepted: 02 December 2020 Published: 31 March 2021.

doi: 10.21037/aob-20-57

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Immune thrombocytopenia is a rare heterogeneous autoimmune bleeding disorder that causes a lower than normal circulating platelet count from both decreased platelet production and accelerated platelet destruction. This is the result of autoantibody and cell-mediated immune responses targeting platelets for destruction . Some ITP patients are fortunate to see their disorder resolve with or without the use of medical intervention . For most patients, living with ITP creates life-long challenges and impacts how they feel and function .

PDSA was patient-founded in 1998 to empower individuals with Immune Thrombocytopenia and other platelet disorders through education, advocacy, research, and support. Today, the organization is a powerful force serving and unifying the global ITP community of patients, practitioners, caregivers, advocates and key disease stakeholders.

What To Do If Bleeding Starts

Bleeding can be a serious concern in someone with a low platelet count. If you begin bleeding, contact your doctor at once. Follow these steps to minimize bleeding:

• Sit or lie down. Try to stay calm.
• Apply pressure to the wound if you can see it.
• Apply an ice pack to the site to slow the bleeding.
• If the wound is on an arm or leg, raise the limb above the level of your heart.
• If you see blood in your urine, increase your fluid intake and call your doctor at once.
• If you notice blood in your vomit, call your doctor. Take anti-nausea medications and antacids as instructed by your doctor.
• If you are bleeding vaginally, do not use tampons. Keep track of how many sanitary pads you are using. Note any clots.

What Can I Do To Prevent Neutropenia

Since white blood cells are destroyed as a side effect of chemotherapy, there is nothing specifically that you can do to prevent neutropenia from occurring. Nonetheless, there are several things that you can do to reduce your risk of getting an infection when your white blood cells are low:

Perform excellent daily personal hygiene.

• Wash your hands frequently, especially before eating and after using the bathroom.
• Use alcohol-free, antiseptic mouthwashes daily.
• Do not cut or pick at cuticles. Use a cuticle cream instead. Even if you have a manicure, only cuticle cream should be used.
• Use a deodorant rather than an antiperspirant. Antiperspirants block sweat glands and, therefore, may promote infection.
• When menstruating, use sanitary napkins rather than tampons, which may promote infection in a neutropenic patient.

Avoid situations that will increase your chance of getting an infection.

• Stay away from people who are ill.
• Avoid contact with anyone who has recently been vaccinated, including infants and children.
• Avoid crowds as much as possible. When going to places where there are often a lot of people , try going at off-peak times, when they are not as crowded.

Use extra precautions to decrease the chance of injury and infection.

If you cut or scrape the skin, clean the area immediately with soap and water and bandage as necessary.

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When To Call The Doctor

• Bleeding that does not stop after applying pressure for 15 minutes.
• Bleeding from the rectum, blood in the stool, or black stools.
• Blood in the urine or dark colored urine.
• A change in your vision.
• Persistent headache, blurred vision, or a change in your level of consciousness such as decreased attention span, excessive sleepiness, confusion, or difficulty being awakened.

*If you have a major injury or start spontaneous bleeding, go immediately to the nearest emergency room.

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Treatment For Low Platelet Count

Low platelet count is not something that should be taken lightly or ignored, and if you find that you are suffering from this condition you need to make sure you get treatment right away.

First, the doctor will need to figure out exactly why you are suffering from low platelet counts.

If the cause for the low platelet count is an infection they will likely give you supplements to raise the number of platelets along with the antibiotics and other medication that you are taking.

There are other treatments as well, one is Corticosteroids.

Corticosteroids usually include Dexamethasone or prednisone and are typically prescribed to raise a patients platelet count.

The patient has to take it once a day and it usually comes in the form of a pill or tablet.

With this medication, an increase or at the very least, normalized, the platelet count is generally seen within 2 weeks of prescribing the medicine, especially with high-dose dexamethasone.

However, the dosage will likely be reduced gradually over the next 4 to 8 weeks.

In some cases, this treatment may have to be repeated, but in most cases, once the platelet count is normal, the patient just gets better eventually as energy levels come back to normal.

IVIG or Intravenous Immuno-globulin is another effective treatment, especially if the platelet count does not come up with prednisone or if the person is not able to tolerate steroids.

Surgery is one of the less taken options for a low platelet count.

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How Is Thrombocytopenia Managed Or Treated

You might not need treatment if a low platelet count isnt causing significant problems. Often, healthcare providers can improve platelet counts by treating the underlying cause. This approach may involve changing your medications.

Other treatments include:

• Blood transfusion to temporarily increase platelet levels in your blood. Platelets are transfused only if the platelet count is extremely low.
• Splenectomy or removal of the spleen.
• Steroids , immunoglobulins , and other medications that reduce platelet destruction and stimulate platelet production.

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How Is Thrombocytopenia Diagnosed

Thrombocytopenia or Idiopathic Thrombocytopenia, which refers to low platelet count without any known cause, can be diagnosed in a number of ways.

ITP is suspected when a patient comes in with specific complaints and shows no history of any other disorders or substance use that would otherwise cause such a problem.

The doctor may use a number of diagnostic means to diagnose Thrombocytopenia, some of which are given below.

The doctor may ask some questions regarding what symptoms, most importantly any bleeding you may have noticed.

They may ask when did you first see them, or if anything makes them better or worse, information about any medications and supplements you may be taking.

They may also want to know if you have had any shots in the last month or a blood transfusion, or used drugs with a needle?

Some questions may feel scary but you have to try to answer them as honestly as you can so a diagnosis can be made.

They may also want to know if you have any family history of excessive bleeding and other blood-related disorders.

The doctor may also check for signs of bleeding, both internal and external, and palpate your stomach to see if your spleen seems big.

There are some tests to check for low platelet levels as well:

· CBC . This test aims to measure the total number of your red and white blood cells as well as platelets.

· Blood smear is a test used to see how your platelets look under a microscope.

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What To Do If You Develop An Infection

If you develop an infection, your doctor will order medications to treat the infection. Depending on the cause and severity of the infection, the medications may be given either by mouth or through a vein using an intravenous catheter. If you require IV medications, accommodations can be made for you to receive them in our office or possibly at home. Some patients require admission to the hospital in order to effectively treat their infection.

If necessary, your oncologist may decide to delay further treatments until your white blood cell count has returned to normal levels and/or you are free of infection.

What Questions Should I Ask My Healthcare Provider

You may want to ask your healthcare provider:

• Why did I get thrombocytopenia?
• What is the best treatment for me?
• Are there any treatment risks or side effects?
• What changes can I make to minimize bleeding and bruising?
• Should I watch for signs of complications?

A note from Cleveland Clinic

If you have conditions that increase your risk for thrombocytopenia, its important to take precautions to protect your health. A low platelet count can put you at risk for excessive bleeding and bruising. Your healthcare provider can explain whats causing the low platelet count and discuss treatment options. If your condition is severe, you may need to avoid activities that increase your risk of injury and bleeding.

Last reviewed by a Cleveland Clinic medical professional on 11/23/2020.

References

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Reducing Your Risk Of Bleeding

If you have very low platelet levels, there are some precautions you can take to reduce your risk of bleeding.

Food, drink and medicines

• Try to limit how much alcohol you drink as it can make bleeding worse.
• Check with your doctor before taking any over-the-counter medicines, supplements or herbal remedies.
• Do not take aspirin or other blood-thinning medicines unless your doctor has told you to.
• Avoid using enemas or suppositories.

Activities

• Be very careful when you use knives, scissors or other sharp tools.
• Avoid high-impact sports and contact sports .
• Wear gloves and clothes that cover your skin to help protect you from scratches and cuts if you do activities where you might injure yourself .
• Wear shoes or slippers to protect your feet from injuries.

Hygiene

• Brush your teeth gently using a soft toothbrush. Avoid flossing to prevent your gums bleeding.
• Be gentle when blowing your nose to help prevent nosebleeds.
• Use an electric razor instead of wet shaving.
• Use sanitary towels instead of tampons.
• Use a water-based lubricant during sex.

What Are The Signs Of A Low Platelet Count

If your platelet count is low, you may not have any symptoms or signs. A simple blood test could find this condition before you notice any changes. If you have any of these signs, talk to your health care team right away:

• More bruises, or worse bruises, than usual

• Small purple or red dots under your skin

• Nosebleeds or bleeding gums

• Muscle or joint pain

• Feeling weak or dizzy

When you have a low platelet count, your body may have difficulty stopping bleeding from a nosebleed or a cut.

Managing a low platelet count and other cancer side effects is an important part of your medical care and treatment. This type of care is called palliative care or supportive care.

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Leukemia Bruising On Legs

Bruising. Frequent and easy bruising is one common symptom of leukemia. However, the bruising that results from leukemia is somewhat different from regular bruising. Seek medical treatment if you have bruising that: Occurs in unusual places, like on your back, your hands, or your legs..Although bruises from leukaemia are very similar to ordinary bruises, there are a few things you can look out for to help spot the difference: They occur in unusual places In cases of leukaemia, quite often bruises will appear in places that you wouldnt normally expect, especially the back, legs,.Leukemia Bruising on Lower Legs. Leukemia is yet another common cause of sudden, unexplained bruising. This is a blood disorder that begins in the bone marrow when the.

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Stopping Treatments Or Medications That Cause Leukopenia

Sometimes you may need to stop a treatment to give your body time to make more WBCs. Your blood cell counts may naturally rise when treatment like radiation is over or between chemotherapy sessions. The amount of time it takes for WBCs to replenish varies from person to person.

If youre taking a medication that causes leukopenia, your doctor may adjust the dose that youre taking. They may also recommend switching to a different medication, if possible.

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Treatment Of Low Platelets

It is important to identify the cause of low platelets. When the cause is clear, treatment can usually help your levels return to normal.

If you are receiving therapies that affect your platelet count, such as cancer treatment, your platelets should return to normal once the treatment ends. Keep in mind that the timeline is different for everyone.

In some cases, a platelet transfusionmay be needed. This is a procedure where you receive platelets from a donor through a vein. A transfusion can help prevent complications from bleeding.

Autoimmune conditions can be treated with drugs that suppress your immune system. This will help stop the destruction of platelets.

When low platelets are caused by medication, the solution is often just switching medications. Your doctor will help you find the right alternative drug.

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What Causes Idiopathic Thrombocytopenic Purpura

In ITP, the immune system is stimulated to attack your bodys own platelets. Most often this is a result of antibody production against platelets. In a small number of cases, a type of white blood cell called T-cells will directly attack platelets. This immune system error may be a result of any of the following:

• Medications can cause an allergy that cross-reacts with platelets.
• Infections, typically viral infections, including the viruses that cause chicken pox, hepatitis C, and AIDS, can prompt antibodies that cross-react with platelets.
• Immune disorders, such as rheumatoid arthritis and lupus
• Low-grade lymphomas and leukemias may produce abnormal antibodies against platelet proteins.
• Sometimes the cause of immune thrombocytopenic purpura is not known.

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Associated Symptoms Of Bleeding After Menopause

These are common symptoms you might encounter along with vaginal bleeding after menopause:

• Cramping or Abdominal Pain

• Rapid heart rate or fast heart rate as a result of hypovolemia
• Sudden weight gain or loss
• Fever and chills with ill feeling associated with infection

These symptoms indicate presence of further problems in a woman and these should not be ignored. Early detection of underlying causes is important to immediately implement certain treatments.

What Does Low Platelet Count Mean Definitions And Meaning Of Low Platelets

Low platelet count is medically known as Thrombocytopenia.

It causes fatigue, among other things, which makes you feel like not doing anything.

Symptoms and signs of thrombocytopenia may also be bleeding and not clotting in time after getting hurt.

Thrombocytopenia or low platelet count is when there is lower than a normal number of platelets in the blood.

Thrombocytopenia can be an inherited or acquired condition and can occur in situations such as when there is the use of certain drugs.

The Causes of thrombocytopenia can be divided into three broad groups depending on how it happens:

· Diminished production

· Increased destruction

· Sequestration

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Signs And Symptoms Of Light Chain Amyloidosis

Patients with amyloidosis can have some of the same problems as patients with myeloma, such as kidney problems and nerve damage. They can also have other problems, such as:

• Heart problems: The heart may enlarge and become weaker. In some people, the heart becomes so weak that fluid builds up in the lungs, making them feel short of breath. Fluid may also build up in the legs and feet . This is called congestive heart failure.
• Enlarged liver: The person may feel the liver below the right ribs. When this gets large it can press on the stomach so the person feels full after eating only a small amount of food.
• Enlarged tongue: When amyloid builds up in the tongue it can get larger. This can lead to problems swallowing and problems breathing during sleep .
• Skin changes: Changes in the color or texture, easy bruising, and bleeding into the skin around the eyes
• Kidney problems

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How Low Blood Platelet Counts Develop

Platelets in the blood are constantly renewed by bone marrow, and counts stay normal and consistent through a process of ongoing production and destruction. In healthy people, platelets wind up dying off after about 10 days, at which point theyre replaced by new ones. But in people with low platelets, there are either less platelets being produced, or a faster removal of platelets, which keep counts abnormally low.

Bone marrow is the sponge-like tissue inside the bones, which contains very valuable cells called stem cells. Stem cells mature and develop into various types of blood cells, including red blood cells, white blood cells and platelets. Someone who experiences damage to stem cells inside the bone marrow isnt able to make the necessary blood cells and platelets needed to properly clot blood. People with normal blood platelet counts have between 150,000450,000 platelets per microliter of circulating blood, but those with low counts can have much less.

According to the American Society of Hematology, thrombocytopenia can be caused by genetic/inherited factors or as a side effect of peoples lifestyles, including the medications they take, their diets and their medical histories, which all affect how their spleens and bone marrow function. Genetic mutations can cause thrombocytopenia due to diminished production or shortened life span of platelets related to alterations in transcription factors, cytokines, cell surface receptors and signaling molecules.

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