Patient Information Resource:
Benign Hematologic (Blood) DisordersA collaborative project of the Arizona Telemedicine Program, the Arizona Health Sciences Library and the Arizona Cancer Center.
See: GENERAL DISCLAIMER
Platelet Abnormalities
A. Decreased Platelet Levels
Bleeding may occur if platelet levels are too low or if platelet function is abnormal. Bleeding due to a platelet problem occurs in the first few hours following injury when platelets would normally be responsible for plugging the wound site.
Thrombocytopenia is a reduction in platelet levels in the blood. This may be caused by decreased platelet production or increased platelet destruction.
Thrombocytosis is an excess of platelets in the blood. This excess of platelets leads to increased clot formation followed by excess bleeding. Thrombocytosis can occur in diseases such as polycythemia vera, myelofibrosis with myeloid metaplasia, chronic granulocytic leukemia, and primary thrombocytosis.
B. Decreased Platelet Quality
Various factors may decrease platelet function in the blood.
Uremia. Bleeding may be a serious problem of either acute or chronic kidney failure. Kidney failure causes uremia, an excess of wastes in the blood which are normally removed in the urine. These toxic substances interfere with platelet function, causing excess bleeding. Other symptoms of uremia include nausea, vomiting, weight loss, metallic taste in the mouth and odor on the breath, itching, a frosty look to the skin, muscle pain and twitching, increased blood pressure, swelling and water retention, and mental confusion. The disorder is confirmed by physical and laboratory diagnosis of kidney failure. Treatment focuses on correcting the kidney condition or improving platelet function. Kidney disease may be addressed with dialysis or successful kidney transplant. Most patients with kidney failure are anemic. Since improving anemia may result in improved platelet function, treatment may include red blood cell transfusion and erythropoietin hormone replacement (see Anemia). Medications such as desmopressin (DDAVP), cryoprecipitate (concentrated blood clotting proteins), and conjugated estrogens such as Premarin have been shown to reduce the bleeding time.
Hepatocellular disease. Hepatocellular disease is disease of the liver. Examples include cancers such as hepatocellular carcinomas and adenomas. Advanced liver disease often results in platelet dysfunction and bleeding. Platelet levels are often decreased in liver disease because an enlarged spleen traps platelets so they cannot reenter the bloodstream. In patients with a history of alcohol abuse, low platelet levels may be caused by the toxic effects of alcohol on platelet production in the bone marrow. Low platelet levels can be treated by platelet transfusions and administration of DDAVP. Please see Liver Cancer.
Dysproteinemia. In dysproteinemia, increased blood levels of abnormal proteins interfere with normal platelet function. Abnormal proteins are present in diseases such as multiple myeloma and macroglobulinemia. Dysproteinemia and its underlying cause are diagnosed by physical examination and laboratory testing. Treatment involves addressing the underlying disease. Plasmapheresis, or plasma exchange, may be used to control bleeding.
Vitamin deficiencies. Vitamin B12 and folate are necessary for platelet production. Deficiencies in either vitamin may lead to bleeding. These deficiencies may be caused by diet or other factors. Please see Vitamin B12 Deficiency and Folic Acid Deficiency.
Myeloproliferative disorders. Platelets are produced in the bone marrow. Therefore, diseases of the bone marrow, such as myeloproliferative disorders, may be further causes of platelet dysfunction. Myeloproliferative disorders may result in decreased platelet levels or decreased platelet function. Please see Myeloproliferative Disorders.
Drug-induced platelet abnormalities. Drugs such as aspirin and other nonsteroidal anti-inflammatory agents (Advil, Excedrin) inhibit platelet function. These anti-platelet medication interfere with platelet aggregation at the wound site. In addition, many medications such as heparin or sulfa antibiotics such as Bactrim result in decreased platelet levels or function.
GENERAL DISCLAIMER: This web site and its contents are designed for educational purposes only. This web site does not render medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, you should consult your health care provider.
Updated: October 30, 2000