Low Platelet Count In Children: Causes, Diagnosis & Treatment

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Low platelet count or thrombocytopenia is when the number of platelets in the blood is below normal. Platelets are produced in the bone marrow and stick together at the injury site to help the blood clot. When the platelet count decreases, children are at risk of bleeding (1).

Platelets only live for ten days, after which the bone marrow produces new platelets. Thrombocytopenia in children occurs when the bone marrow cannot make enough platelets, the platelets break down more rapidly than normal, or are trapped in the spleen (an organ that filters blood) (2).

Thrombocytopenia is a rare condition but occurs more commonly in children than in adults. However, it usually goes away without treatment (3).

Read the post to learn about the causes, symptoms, diagnosis, and treatment for low platelet count in children.

What Causes Low Platelet Count In Children?

The platelet count in children normally ranges from 150,000 to 450,000 platelets per microliter of blood. If the platelet count goes below 50,000, there is a risk of serious bleeding after an injury (4). Some of the causes for low platelet count in children are (1) (5)

1. The bone marrow is unable to make adequate platelets

The bone marrow is a spongy tissue inside the bones and contains stem cells, which are responsible for making blood cells. When stem cells are damaged, the production of platelets is affected. Some factors that damage the stem cells are

  • Cancers, such as leukemia or lymphoma
  • Chemotherapy or radiation therapy
  • Aplastic anemia (a blood disorder where the bone marrow stops making blood cells)
  • Exposure to toxic chemicals such as pesticides
  • Medicines, such as chloramphenicol (an antibiotic), aspirin, or ibuprofen
  • Viral infections, such as mumps, rubella, and chickenpox,
  • Genetic disorders, such as Wiskott-Aldrich and May-Hegglin syndromes

2. The body breaks down the platelets

Even when the bone marrow produces sufficient platelets, thrombocytopenia may occur if the body destroys its healthy platelets. Some factors that cause this condition are

3. The spleen traps too many platelets

Normally, the spleen holds one-third of the body’s platelets. However, if the spleen gets enlarged due to certain diseases, it traps more platelets, thus preventing them from circulating in the blood and reducing the platelet count.

What Are The Symptoms Of A Low Platelet Count In Children?

If the platelet count is not too low, there may not be any visible symptoms. However, if the platelet count is considerably low, children may experience one or more of these symptoms (1) (3) (6):

  • Easy bruising or petechiae (small red, purple, or brown spots on the skin)
  • Gum or nose bleeding that is difficult to stop even after applying pressure
  • Continuous bleeding from small wounds
  • Blood in urine or vomit
  • Black stool (indicating blood in the stomach or intestines)
  • Fatigue

In some serious cases, bleeding can occur in and around the brain, causing headaches or changes in thoughts and behavior. Internal bleeding requires immediate medical attention (5).

How Is Low Platelet Count Diagnosed In Children?

If healthcare providers suspect low platelet count in children, they may diagnose it using the following methods (1) (5) (7):

  1. Medical history analysis: Inquiring about the child’s medical history, including any present medication, eating habits, and family history of low platelet count.
  1. Physical examination: Checking for any signs of bruises, spots, or infections. They will also examine the child’s abdomen to check for signs of an enlarged spleen or liver.
  1. Diagnostic tests: Your child’s healthcare provider may suggest the following diagnostic tests:
  • A complete blood count test to determine the level of blood cells (red and white blood cells and platelets)
  • A blood smear to check the appearance of the blood platelets under the microscope
  • A blood clot test to determine the time taken for the blood to clot.
  1. Bone marrow tests: If thrombocytopenia is confirmed, one of the following bone marrow tests is done to determine its cause:
  • Bone marrow aspiration, where some fluid is taken from the bone marrow through a needle and tested under the microscope
  • Bone marrow biopsy, where a small sample of bone marrow is taken and examined.
  1. Imaging tests: Imaging tests, such as ultrasound or CT scans, are suggested to check the spleen, liver, and lymph nodes.

How Is Low Platelet Count Treated In Children?

The treatment of low platelet count mainly depends on its cause and severity. No treatment is required when the platelet level is not extremely low or if the child has inherited the condition.

However, in severe cases, different forms of treatment are used to deal with the underlying cause of low platelet count (2) (5):

  1. Treating the cause: If the platelet count decreases because of certain medications, stopping those medications would bring the platelet level back to normal.
  2. Using steroids or immunoglobulins: If the platelet count drops due to an autoimmune disorder, steroids and immunoglobulins are commonly given to children to control the condition.
  3. Platelet transfusion: Intravenous platelet transfusion helps to temporarily increase the blood platelet level in children at high risk of bleeding.
  4. Removing the spleen: A splenectomy is done in rare cases where the spleen traps too many platelets and cannot be corrected with medication.

In most cases, thrombocytopenia in children does not require treatment and resolves on its own. However, children should avoid falls and contact sports, such as football or rugby, to prevent the risk of head injuries and bleeding. They should also stop taking ibuprofen or aspirin and enema or suppositories. Consult your child’s doctor to understand what precautions are necessary to manage the condition effectively.

Key Pointers

  • Low platelet counts in children can be caused by the bone marrow’s failure to generate platelets or the body’s breakdown of platelets.
  • Gum or nose bleeding, blood in urine or vomit, black stool, and bleeding more than usual from minor wounds are signs of low platelet levels.
  • Medications for autoimmune illnesses, splenectomy, or platelet transfusions may be used to treat a low platelet count, depending on the severity and cause.

References:

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Dr. Dur Afshar Agha

(MS)
Dr. Dur Afshar Agha is a consultant pediatrician with decades of experience in various medical facilities both in Pakistan and Saudi Arabia. She has headed the Department of Preventive Pediatrics at the prestigious, Children’s Hospital and Institute of Child Health in Pakistan and is a life member of the Pakistan Paediatric Association. She has also completed her Post Graduate Program... more

Pragya Bhargavi

Pragya Bhargavi has been in the field of content research, writing and editing for over five years. Her passion for academics and science has enabled her to write creative as well as research-based articles. She has completed her Masters in Microbiology and obtained a Bachelor’s degree in Education (B.Ed). As a writer at MomJunction, Pragya aims to bring about a... more