Platelet is also referred as throbocytes. Low platelet count is called thrombocytopenia. Platelets are one type of blood cells, the other being white blood cells and red blood cells. They are produced in the bone marrow. The main function of platelet is hemostasis which means they are involved in clotting mechanism. When bleeding occurs in any part of body, platelet releases thread- like fibers to form clots. If the number of platelets is low, there is increased risk of bleeding. Adults as well as children can suffer from low platelet count.In many cases the cause may be same but sometimes certain causes can be exclusive among children and infants. Usually low platelet count can occur if they are destroyed in the bone marrow or if there is reduced production of platelets or if there is increased sequestration. Children with thrombocytopenia bruise easily due to even minor injury. There is increased risk of bleeding from nose, mouth, and gastrointestinal tract as compared to other normal children.
Causes of Low Platelet Count in Children:
There are numerous causes for low platelet count in a child.
Decreased production of platelet:
- Platelets are produced in the bone marrow. Anything pathology that affects bone marrow can reduce production of platelets. For example blood cancer such as leukemia can stop production of platelets in the bone marrow. It may not only affect the production of platelet, production of other cells is also affected.
- Viral infection: Certain viral infections are known to lower platelet count. For example dengue viral fever, Epstein-Barr disease, mumps etc.
- Medicines: Children taking chemotherapy or radiation therapy for any type of cancer.
Destruction of platelets: A condition called idiopathic thrombocytopenic purpura (ITP) is a leading cause for destruction of platelets in children. It is an autoimmune disorder in which the body mistakenly presumes platelets as foreign body and starts process of destroying. In children it mainly develops between 2 to 7 years of age. Viral infection of respiratory or gastrointestinal tract precedes the ITP. Children with ITP often develop symptoms such as easy bruising, nose bleeding, gum bleeding, tiny hemorrhagic red spots under skin. In rare cases there may be intracranial bleeding.
Other cause for ITP is hemolytic-uremic syndrome (HUS). The causative pathogen is certain strain of E. coli bacteria. It is the bacterium that is responsible for food poisoning and diarrhea.
Increased sequestration: Spleen is a part of immune system. In certain cases the spleen may usurp many platelets that are still healthy and circulating in the blood. This may cause low platelet level in blood. Certain conditions which causes enlargement of spleen such as cirrhosis of liver, malaria, dengue etc can lead to low level of platelets.
The normal platelet count is around 150000 to 400000. Low platelet count is below 150000. In cases of low count, there is increased tendency to bleeding. A child with thrombocytopenia may present with following symptoms:
- Easy bruising even with minor injury.
- Bleeding from nose
- Bleeding from gums which do not stop easily.
- Tiny petechiae hemorrhage. These are tiny red spots on skin surface.
- Abnormal color of urine. It can be red or brown. This is an indication that the child is bleeding from urinary tract.
- Stool may be dark black due to bleeding from upper GI tract.
- Vomiting consists of dark brown coffee like products.
- Headache due to increased bleeding.
- After any injury, bleeding continues too long.
Low platelet count can be diagnosed by a blood test called complete blood count (CBC). The treatment of low platelet count may depend on many factors such as the age of child, overall health of child, any history of underlying disease etc. Often when the child is undergoing chemotherapy the count is low. In such cases the doctor monitors the child closely for any bleeding. If the count is extremely low or if the child is bleeding due to low count, he may need platelet transfusion.
Usually doctors start transfusion when the platelet count falls below 20000 or if there is bleeding from nose, gums, in stool or urine. Along with platelet transfusion, sometimes doctors also administer intravenous immune globulin.
The most necessary step is to prevent bleeding in the child. Certain precautionary measures are beneficial.
- Child must use soft toothbrush.
- Avoid playing games that increase risk of injury.
- Eat foods that are soft and bland. Child must avoid eating spicy and sharp edge food products.
- Nose must be blown very softly.
- Intramuscular injections must be avoided.
- Do not give the child aspirin or any NSAID’s.
- Do not put anal suppository as it may increase the risk of trauma in anus.