All you need to know about Thrombocytopenia in Children 

Overview 

You can develop thrombocytopenia if your blood platelet count is low. Blood cells without colour, called platelets (thrombocytes) aid in blood clotting. In blood artery damage, platelets gather, and form plugs to stop bleeding. 

An immune system issue or a bone marrow illness like leukaemia can lead to thrombocytopenia. Alternatively, it can be a negative drug interaction. Both children and adults are impacted by it. 

Mild cases of thrombocytopenia might manifest with minimal signs or symptoms. Rarely can the level of platelets become so low that life-threatening internal bleeding takes place. There are various treatment possibilities. 

Types of thrombocytopenia 

Acute ITP 

Acute ITP is thought to originate from a temporary alteration in a child’s immune system’s behaviour brought on by viruses like the one that causes chickenpox. 

Children ages 2 to 6 are more likely to experience this problem. Most of the time, the symptoms are minor and disappear on their own in about six months. Nevertheless, 1 in 5 affected children go on to develop chronic ITP. 

Chronic ITP 

This is uncommon in early children but more prevalent in adults, especially female adults. It may require specialised care and endure for several months or a lifetime. Chronic ITP in some individuals appears to go away but frequently returns. 

Infections 

Numerous viral disorders have the ability to lower platelet counts and induce secondary thrombocytopenia. These ailments include malaria, dengue fever, and HIV, among others. 

Some diseases, like malaria, can cause a child’s platelet levels to drop significantly. According to the scientists, thrombocytopenia may serve as a trustworthy predictor. 

Aplastic anaemia 

Thrombocytopenia can be brought on by a type of bone marrow failure known as aplastic anaemia. Less red, white, and platelet production occurs as the bone marrow slows down. 

The majority of the time, aplastic anaemia occurs for no apparent reason; this type is known as idiopathic aplastic anaemia. However, some kids could get it from their parents or get it because of an illness. Between the ages of 1 and 5 years or between the years of 12 and 20 years, bone marrow failure typically manifests. 

MYH9-related thrombocytopenia 

This form of thrombocytopenia is unique because the lower platelet count is caused by a genetic mutation rather than the immune system targeting the body’s platelets. 

The MYH9 gene is in charge of producing proteins that are found in some blood cells, such as platelets. This mutation can be inherited from a person’s parents or can appear on its own. The MYH9 gene can be mutated in a number of illnesses, all of which can result in thrombocytopenia: 

• Epstein-Barr virus 
• Syndrome of Fechtner 
• Anomaly of May-Hegglin 
• Sebastian disease 
• Drug-induced thrombocytopenia 

In infants and other young children, thrombocytopenia can arise as a reaction to treatment, and this can be fatal. 

A newborn who had ranitidine (Zantac) for difficulty eating saw a substantial decline in platelet count, also used to treat acid reflux is ranitidine. More research is necessary to fully comprehend how ranitidine and other medications affect newborns’ and young children’s platelet counts. 

Causes 

Less than 150,000 platelets per microliter of blood in circulation is considered thrombocytopenia. Since platelets only last for around 10 days, your body typically continuously replenishes your platelet supply by manufacturing new platelets in your bone marrow. 

Rarely is thrombocytopenia inherited; instead, it can be brought on by several diseases or drugs. Whatever the source, circulating platelets are lowered because of one or more of the following processes: platelets becoming trapped in the spleen, platelet production declining, or platelet degradation increasing. 

Stuck platelets 

The spleen is a little organ the size of your fist that is found on the left side of your abdomen, directly below your rib cage. Normally, your spleen fights infections and removes impurities from the blood. Too many platelets can accumulate in an enlarged spleen, which can be brought on by a variety of diseases. This reduces the amount of platelets in circulation. 

Decreased platelet production 

Your bone marrow produces platelets. There are several elements that can reduce platelet production such as:

• The malignancies leukaemia and others 
• Various forms of anaemia 
• Viral illnesses like hepatitis C and HIV 
• Radiation therapy and chemotherapy 
• Excessive alcohol use 
• Increased breakdown of platelets 

There may be a deficiency of platelets in your bloodstream due to certain disorders that allow your body to use up or destroy platelets more quickly than they are created. Such situations include, for instance: 

Pregnancy 

Pregnancy-related thrombocytopenia often resolves quickly after childbirth and is mild. 

Immune thrombocytopenia 

Autoimmune conditions including lupus and rheumatoid arthritis bring on this kind. Platelets are wrongly attacked and destroyed by the body’s immune system. Idiopathic thrombocytopenic purpura is the term used when the precise cause of this illness is unknown. Kids are more frequently impacted by this category. 

Blood contains bacteria 

Platelets can be destroyed by severe blood-borne bacterial infections (bacteremia). 

Thrombotic thrombocytopenic purpura 

This is an uncommon illness that develops when numerous platelets are quickly depleted by tiny blood clots that appear abruptly all over your body. 

Hemolytic uremic syndrome 

This uncommon condition inhibits kidney function, destroys red blood cells, and produces a dramatic decline in platelets.

Symptoms of thrombocytopenia 

A few symptoms and signs of thrombocytopenia in children include  

• Typically present on the lower thighs. 
• Prolonged bleeding from cuts 
• Excessive bruising 
• Blood in urine or stools 
• Fatigue 
• Bleeding from your gums or nose 
• Enlarged spleen 
• Hefty menstrual flows 

Diagnosis 

The National Institute of Heart, Lung, and Blood. According to a trusted source, when diagnosing and determining the reason of thrombocytopenia, clinicians take into account a patient’s medical history, the findings of a physical examination, and test results. 

Medical history 

A doctor may inquire about anything that might have an impact on platelet levels, such as: 

The consumption of both prescription and over-the-counter medications, general dietary practices, and any history in the family of low platelet counts or associated illnesses. 

Inspection of the body 

The doctor looks for signs of bleeding and bruising during this time. They might also keep an eye out for signs of an infection, including a fever. 

Diagnostic procedures 

When a doctor detects thrombocytopenia, they perform numerous tests that can also reveal the underlying source of the problem. These tests could consist of the following: 

Complete blood count results: Low platelet levels are confirmed by the results. A blood smear reveals if the platelets seem to be in good shape. 

Bone marrow tests: This verifies the health of the bone marrow. 

Prothrombin time test: This gauge how quickly blood clots. 

Treatment 

The course of treatment for thrombocytopenia in children is determined by both the underlying cause and the severity of the symptoms. For instance, a youngster with mild acute ITP is probably not in need of therapy because the condition usually goes away on its own. The youngster might require a blood or platelet transfusion if they have a significant risk of bleeding heavily. 

A youngster with persistent ITP that recurs regularly may require immunosuppressive medicine, such as rituximab. The doctor might recommend corticosteroids, which delay platelet deterioration if an infectious disease like HIV is to blame. Treatment for thrombocytopenia aims to avoid major side effects overall. The doctor will concentrate on treating both conditions if the low platelet count is a symptom of an underlying medical disease. 

When to see a doctor  

If you are concerned about any thrombocytopenia symptoms, schedule a consultation with your doctor. An emergency situation when bleeding won’t stop. If bleeding cannot be stopped using the standard first-aid methods, such as applying pressure to the area, seek immediate medical attention. 

Summary 

Low quantities of platelets in the blood are referred to as thrombocytopenia, which might increase the likelihood of bleeding and bruising easily. The most frequent type of thrombocytopenia in children is acute ITP, which often goes away on its own after six months.  

Medication side effects, infections, and genetic mutations are a few less frequent reasons for thrombocytopenia. A youngster may not require therapy if their symptoms are extremely minor. A child with persistent ITP may need immunosuppressant medicine and be at risk for serious bleeding. 

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