Managing Low Platelet Counts (Thrombocytopenia) in Children: Causes, Symptoms, Diagnosis and Treatment

How to Manage Low Platelet Counts in Children?

Low platelet count in children can predispose them to bleeding tendency. Knowing the whys and hows of this condition can reduce anxiety in parents and help in effective management. 

What is Thrombocytopenia? 

Low platelet count, medically termed thrombocytopenia, is a condition that can cause significant concern for parents. Platelets are essential blood components responsible for clotting blood and preventing excessive bleeding. When their levels drop, the body may face challenges in healing wounds or preventing spontaneous bleeding. Understanding the causes, symptoms, and management of thrombocytopenia is crucial to ensure a child’s well-being.

The normal range of platelets is 150,000 to 450,000 platelets per microliter. Depending on the severity, thrombocytopenia can be

• Mild: When platelet levels are between 101,000 and 140,000 per microliter of blood.
• Moderate: When platelet levels are between 51,000 and 100,000 per microliter of blood.
• Severe: When platelet levels are between 51,000 and 21,000 per microliter of blood.
• Very severe : If platelet count drops to below 20,000 per microliter of blood Children with mild cases might not show symptoms, while severe cases can lead to dangerous bleeding episodes.

What are the causes of Thrombocytopenia in children? 

There are several reasons why a child may develop low platelet count. Broadly, either the bone marrow does not produce enough  platelets, or other conditions in which ,either there is excess consumption or  destruction of  the circulating platelets. 

• Immune Thrombocytopenic Purpura (ITP): A condition where the immune system mistakenly attacks the self platelets and destroys them. 
• Bone Marrow Disorders: Conditions like leukemia or aplastic anemia can impair platelet production.
• Medications: Certain drugs, including chemotherapy agents and antibiotics, may lead to thrombocytopenia as a side effect.
• Nutritional Deficiencies: Lack of vital nutrients like vitamin B12 or folate can affect platelet production.
• Chronic Conditions: Diseases like lupus or other autoimmune disorders can also lower platelet counts.
• Infections: Viral infections like dengue, Epstein-Barr virus, or cytomegalovirus often lead to transient reductions in platelet levels.

What are the symptoms of Thrombocytopenia?

A child may experience the following symptoms in case of low platelet count. All children do not present with all symptoms, and the presentation varies depending on the extent of thrombocytopenia: 

• Excessive bleeding from minor cuts.
• Small red or purple spots on the skin that can look like rashes (petechiae).
• Frequent bruising (blood pools under the skin)
• Nosebleeds or gum bleeding.
• Blood in urine or stool.
• Blood in vomit
• Menorrhagia: Heavy periods, with bleeding lasting more than seven days

What tests will my child need to confirm the diagnosis of thrombocytopenia? 

After a detailed history and physical examination, the doctor may advise for diagnostic tests depending on the specific needs of the child. Complete blood picture, peripheral blood smear; tests like prothrombin time, and partial prothrombin time to test for clotting, and bone marrow biopsy are some tests that can be prescribed. 

Pediatric hematologists and oncologists are specialized in handling blood disorders and cancers in children. 

Managing Low Platelet Counts in Children

The approach to managing thrombocytopenia depends on its underlying cause and severity. Below are some strategies that can be employed by your expert to manage and treat this condition:

• Identify and Treat the Cause: Since the reduction in platelet count is an effect of an underlying problem, treating the concern is the aim. For example, if a viral infection is responsible, the condition often resolves on its own as the infection clears.

• Monitor Platelet Levels: Regular blood tests may be required to track platelet counts and determine if further intervention is necessary.

• Medications and Interventions: Corticosteroids may be needed in some conditions like Idiopathic Thrombocytopenic Purpura to boost platelet production. For severe thrombocytopenia, platelet transfusions might be needed to prevent life-threatening bleeding. Medications to modulate  the immune system may also be considered in autoimmune-related cases.

• Splenectomy: In healthy cases the spleen stores about one-third of the platelet supply. In some cases of thrombocytopenia, however, the spleen traps and destroys platelets.  Splenectomy may be rarely considered in severe cases if the diagnosis points towards such a cause.  

Avoidance of Bleeding Risks- What Parents Should Know?

In case a child is diagnosed with thrombocytopenia, especially long-term, the parents should be aware of some essential precautions. 

• Children should avoid heavy contact sports or activities that could lead to major injuries.
• A soft bristle toothbrush should be used to prevent gum bleeding 
• A safe environment that prevents falls, bruising by table/bed edges, etc should be created for children
• Nutritional Support: A balanced diet rich in vitamin B12, folate, and iron supports overall blood health. Foods like leafy greens, eggs, dairy, and fortified cereals are beneficial.
• Travel support- A child should always be encouraged to sit in the car seat or wear a seat belt when in a four-wheeler. On a bike or public transport, children should be held safely to prevent unwanted injuries from jerking. 

Life-threatening internal bleeding can be a very serious complication in children with thrombocytopenia. Parents should be informed about the signs of severe bleeding and the importance of immediate medical attention if symptoms worsen.

Managing low platelet counts in children requires a comprehensive approach involving early diagnosis, careful monitoring, and targeted treatment. By addressing the root cause and ensuring preventive measures, most children can recover and lead healthy lives. If your child exhibits symptoms of thrombocytopenia, consult a pediatric haematologist and oncologist promptly to determine the best course of action.