Platelets are an important part of overall health. In medicine, a platelet is a type of cell called a thrombocyte. They are found in the blood and have crucial jobs within the body. When a person is cut, these cells work to stop the bleeding. Many platelets work together to create a plug for the cut, called a clot.
Purpose of platelets
Made in bone marrow, a platelet is the smallest cell found
in the blood. As the name suggests, it resembles the shape of a plate. After
the cells are dispatched to the site of an injury, they grow tendrils that
branch out to help them stick to each other and form a clot. Initially, a few
clots arrive to start the foundation layer. Once they have settled into the
site of injury, more platelets arrive and attach themselves to the beginning
layer to create another layer. Clots are made of several layers of platelets.
You may have patients that come in thinking they have an unexpected allergic reaction. Petechiae are very small, circular, non-raised red or purple patches that appear on the skin. Most people don’t know why they get them. They may be found on the surface of the skin, on the eyelids or inside of the mouth. When your platelet count is very low the blood can’t be contained in the arteries. This is one reasons why Idiopathic Thrombocytopenic Purpura (ITP) patients first notice something is wrong by noticing petechiae. If platelets are very low they may also have exercise bleeding and bruising. Small bumps or pressure, like blood pressure cuffs, could result in a purple arm for weeks.
There are many reasons why it
might be necessary for a health professional to measure platelet levels.
Medical staff rely on a complete blood count test to determine these levels. An
ideal level is between 150,000 to 750,000 in each microliter of blood. Anything
above 750,000 is too high, while anything below 150,000 is too low. In both
instances, these abnormal levels can be problematic. This is why CBC blood
counts are a must if you even suspect someone has petechiae or unexplained
bruising. Leukopaks can help in improving blood counts in these patients.
Thrombocytopenia occurs when there are not enough platelets in the blood, and it can lead to uncontrollable bleeding from the smallest cuts. This condition often causes easier bruising and random bleeding from the nose or gums. Several conditions can be the cause, including a kidney infection or specific types of cancer. Any medicine that is used to prevent excess blood clots may also be a cause and can create the need for close monitoring of platelet counts. This can be very problematic as low platelet counts can result In internal organs loosing blood. Brain and heart blood loss could be very critical. A simple fall could result in a lot of damage. A cut or accident can be fatal if platelets are too low.
If a patient has low platelet counts then you will want to double check that you don’t give them blood thinners. Surgery and ports should be avoided if the patient has less than 50,000. No two ITP patients are the same. Most children with ITP can grow up in remission. Most adults who get ITP usually have it chronically. They may have to find a new normal that works for them. No two cases are alike.
Some patients don’t produce platelets. Some are given IVIG for a boost for safety, but that alone won’t get you to remission. Their numbers drop. That could be indicative that the body is destroying the platelets and not just not halting production. Common practices to see if the body is destroying or making platelets can be done in bone marrow biopsies. Some doctors will choose to do a splenectomy if the spleen is believed to be the cause the platelets are being destroyed.
IVIG is given to boost platelet levels, but is not a cure all. Steroids are often prescribed, but have a range of unwanted side-effects and efficacy. Rituximab is another treatment option that can be life saving and keep patients in remission for years or decades. Rituximab is not usually administered with radiation. Unlike other types of Chemo it won’t attack all the bloodcells good and bad. It’s more like a key that only attacks certain cells in the bone marrow. Thus, it’s effects are more pin pointed and specific than other Chemotherapy. Many insurance companies prefer you try other methodology first because of the price tag. However, work with your doctor to advocate for you with the insurance. When your platelets are below 50K you don’t want to sit and wait.
Thrombocytosis is the condition that occurs when platelet counts are too high and can lead to dangerous clot formation, even without any injuries. It is most often caused by an abnormal production of platelets or some conditions such as anemia. If levels are too high, blood clots can form and travel through the veins and arteries, presenting a risk of heart attack.
Platelets are a necessary defense for the body. They may be small, but they have an important purpose. In the process of clotting, they are also preventing bacteria and dirt from getting into the body through open cuts. Deficiencies or overproduction can lead to serious conditions. It is important to work with other medical professionals to keep platelet counts within normal range. Constant communication between a PCP and Hematologist should occur to understand the complexity of the patient’s health history. If you have a patient with ITP, make sure your staff and nurses get trained as often their mistakes in unrelated visits could result in medical advice that is unsound for an ITP patient.