Platelets are crucial blood cells to help you form clots to stop bleeding. If you do not have enough platelets, you can develop a disorder called thrombocytopenia. When you have this condition, you can bleed more easily and have trouble stopping bleeding.
The goal of treatment for thrombocytopenia is to increase your platelet count to lower your risk of bleeding, both internally and externally. An integrative medicine approach can incorporate advanced lab testing and modern approaches to thrombocytopenia diagnosis and management. This way of healing uncovers factors that are causing platelet levels to drop and address them using a holistic management plan individualized to your unique health, lifestyle, and needs.
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What is Thrombocytopenia?
You have a type of blood cell called platelets or thrombocytes that help you make blood clots to stop bleeding. When a tissue is damaged, platelets clump together to form plugs in blood vessels that help stop bleeding. Normally, each platelet lasts only about ten days, and your body continuously renews your platelet supply by producing new platelets in your bone marrow.
Platelet levels have traditionally been measured in the blood single test or as part of a complete blood count (CBC) that looks at various blood cells. When you don't have enough platelets (fewer than 150,000 platelets per microliter of circulating blood), this is called thrombocytopenia. If platelets are just a little low, there may not be noticeable symptoms. But if platelet counts drop too low, increased bruising and bleeding can occur with difficulty stopping bleeding. You might notice superficial bleeding into the skin that forms pinpoint-sized reddish-purple spots (petechiae), prolonged bleeding from cuts and scrapes, bleeding from your gums or nose, blood in your urine or stools, and unusually heavy menstruation. In addition, blood loss can lead to fatigue. In severe cases, when the platelet count falls below 10,000 platelets per microliter, dangerous internal bleeding can happen. You may also develop an enlarged spleen if platelets are being trapped there.
If platelets do not drop too low, treatment may not be necessary. If the platelet count drops too low or symptoms are more severe, treatment can be enacted depending on the underlying cause. For example, if thrombocytopenia is related to a specific medication, it may need to be adjusted or changed. In autoimmune destruction of platelets, the immune system may be suppressed with corticosteroids, immunoglobulins (IVIg), rituximab, or other therapies. In cases of thrombotic thrombocytopenic purpura, plasma exchange may be needed. In other cases, an enlarged spleen will need to be removed with surgery.
Medications like eltrombopag and romiplostim can help your body make more platelets. When platelet counts are dangerously low, a blood or platelet transfusion is often used to replace these blood cells. This boost in platelets lasts about three days.
Since medications like aspirin and ibuprofen (Advil, Motrin IB) can prevent platelets from working correctly, it is often recommended to avoid these for pain management and other purposes. Although omega-3 supplements like fish oil do not impact platelet numbers, they can impact their function, reducing platelet aggregation to impact cardiovascular risk factors favorably.
The Shortcomings of Traditional Thrombocytopenia Management
There are some challenges in traditional thrombocytopenia management and limitations of conventional platelet disorder treatments. An integrative approach incorporating modern precise therapies, a functional medicine-based uncovering of root causes, and a holistic treatment approach can help to address these.
For example, increasing numbers of people are suffering from refractory ITP due to resistance to modern conventional treatment. A more goal-directed approach to management guided by advanced laboratory testing is needed to provide more effective treatment.
Advanced therapy for refractory ITP aims to establish a safe platelet count to prevent clinically significant complications with approaches such as splenectomy, immunosuppressive agents such as rituximab, and thrombopoietin receptor agonists (TPO-RA). These therapies each have unique advantages and adverse effects which can limit their use and effectiveness. For example, older empirical immunosuppression fails to alter the natural progression of disease and brings the risk of more frequent infections and cancer.
To avoid some of these adverse effects and more effectively target the disease process, it is crucial to understand the underlying pathophysiology of the disorder. This type of research has led to the development of new targeted therapies, including inhibitors of the neonatal Fc receptor inhibitors, Bruton tyrosine kinase, and complement pathways.
In addition, expanding methods for identifying biomarkers of response and toxicity will help better match individual patients with the personalized treatment to which they are most likely to respond and tolerate.
Advanced Lab Testing: A Paradigm Shift in Thrombocytopenia Diagnosis
In addition to the traditional approach of measuring platelet levels in the body, functional medicine laboratory testing offers innovations in thrombocytopenia diagnostics that allow for evaluating underlying factors that may be contributing to why they are low. Measuring blood counts can also help to monitor treatment and formulate an individualized management approach.
Utilizing cutting-edge laboratory testing allows for more accurate and early diagnosis that can help identify why your platelets are low. This offers the hope of earlier detection of the issue and assesses the underlying root causes of why platelet levels are low. Precision laboratory tests for platelet disorders also allow for monitoring of progress during treatment.
Blood Counts with Platelet Levels
Platelets can be measured as a single test or as part of a complete blood count (CBC) with differential and platelets. This test measures the level of red and white cells in the blood, including neutrophils, eosinophils, basophils, monocytes, and lymphocytes, as well as platelet count. It also gives information about the size of red blood cells, hematocrit (HCT), hemoglobin (Hgb, Hb), mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH). A peripheral blood smear is another way to examine the size, shape, and number of platelets by viewing them under a microscope. Sometimes, a bone marrow biopsy may be needed to assess platelet production.
More cutting-edge techniques offer increased accuracy. When used in combination, emerging tests like flow cytometric markers of platelet activation, such as P-selectin expression, and bone marrow response, such as immature platelet fraction, can help to distinguish various causes of thrombocytopenia.
In an adult, a normal platelet count should be somewhere between 150,000 and 450,000 platelets per microliter of blood. When platelet counts drop to between 101,000 and 140,000 per microliter of blood, mild thrombocytopenia is present. If they fall further to 51,000 and 100,000 per microliter of blood, this is classified as moderate thrombocytopenia. In severe cases of thrombocytopenia, platelet counts are between 51,000 and 21,000 microliters of blood.
Blood Clotting Test
Platelets are a crucial component of blood clots. The time it takes for blood to clot can be measured with blood tests such as partial thromboplastin time (PTT) and prothrombin time (PT) tests.
Testing for Toxic Exposures
Platelet levels can be impacted by environmental exposures to toxic chemicals like arsenic, benzene, and pesticides. A Heavy Metals screening can measure levels of metals like arsenic in the blood to evaluate exposures. An Environmental Toxins Test can complement heavy metal testing to estimate if various environmental toxins are building up in your body that may impact platelet levels.
Micronutrient Testing
Forms of malnutrition, such as protein-energy malnutrition and specific vitamin and trace element deficiencies, are associated with platelet abnormalities. Vitamin E, vitamin D, vitamin B12, calcium, magnesium, cadmium, cobalt, selenium, iron, omega-3 fatty acids, and zinc can all affect platelet function. People with chronic alcohol abuse are most likely to develop thrombocytopenia when they also have low levels of vitamin B12 or folate. Other nutrients, like very high levels of DHA/EPA, may impact platelet aggregation and cause issues with clotting/bleeding. The state of these nutrients can be measured with a Micronutrient Panel.
Comprehensive Gut Testing
Research shows that thrombocytopenia associated with autoimmune disorders is accompanied by imbalances in the gut microbiome (dysbiosis). For example, people with ITP have greater numbers of bacteria such as Blautia, Streptococcus, and Lactobacillus and fewer numbers of bacteria such as Bacteroides. The GI-MAP by Diagnostic Solutions is a comprehensive stool test that gives a picture of the gut microbiome to assess microbial imbalance and indicators of digestion, absorption, inflammation, and immune function.
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Integrative Medicine's Holistic Approach to Thrombocytopenia
Thrombocytopenia therapy should minimize toxicity and optimize quality of life. The most effective way to do this is an integrative approach that combines conventional medicine with a more holistic view incorporating nutrition, lifestyle, and complementary therapies. It is important to uncover and target root causes and not just generalize treatment based on symptoms.
Integrative medicine solutions for thrombocytopenia are based on an accurate understanding of the underlying factors leading to decreased platelet count and function. Thrombocytopenia can occur due to several causes. The number of platelets circulating in your bloodstream can drop due to trapping in the spleen, decreased production from the bone marrow, or increased destruction.
For example, if the spleen enlarges, it can trap too many platelets and remove them from circulation.
Other disorders, such as leukemia, lymphoma, and other cancers, some types of anemia, viral infections including hepatitis C, CMV, EBV, or HIV, malaria, rickettsial disease, chemotherapy drugs and radiation therapy, and heavy alcohol consumption, can decrease platelet production in the bone marrow.
There are also conditions that cause the body to destroy platelets faster than they can be replaced. For example, immune thrombocytopenia is an autoimmune condition where the immune system attacks and destroys platelets. This condition often accompanies systemic lupus erythematosus and rheumatoid arthritis. It can also occur in an idiopathic form, especially in children, known as idiopathic thrombocytopenic purpura (ITP). Platelets can also be destroyed if you have an infection that spreads to the blood (bacteremia) or due to hemolytic uremic syndrome, a rare disorder that impacts kidney function and causes the destruction of platelets and red blood cells. If the body abnormally produces blood clots, such as in the rare conditions of thrombotic thrombocytopenic purpura (TTP) and disseminated intravascular coagulation (DIC), a large number of platelets can also be used up. In addition, certain medications, such as heparin, quinine, sulfa-containing antibiotics, and anticonvulsants, can cause platelet drop.
Around 5% of pregnant women will experience mild thrombocytopenia just before giving birth, which usually resolves after delivery. Thrombocytopenia can also occur in pregnant women who experience preeclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. In some cases, there are not enough platelets due to inherited or genetic causes.
The Role of Diet and Nutrition in Platelet Health
In many cases, nutrition and lifestyle factors influence the levels of platelets in the blood. In these cases, dietary, supplement, and/or lifestyle approaches can help correct mild thrombocytopenia. An integrative medicine approach creates an individualized management plan by assessing underlying contributing factors and bringing the body back into balance. This can involve dietary interventions for thrombocytopenia that help to normalize platelet levels and function.
Certain nutrients can help to support normal platelet function and number. For example, vitamin B12 and folate are needed for healthy blood cells. Deficiencies in these vitamins are associated with thrombocytopenia. You can incorporate natural sources of vitamin B12 like beef liver, clams, and eggs into your diet. Folate is found in foods like beef liver, spinach, black-eyed peas, rice, asparagus, and avocado. Although fish oil supplements may provide high enough levels of omega-3 fatty acids to impact platelet function, omega-3 from foods generally has a minimal impact on platelet function.
Iron is another nutrient that impacts platelets. Iron deficiency can affect platelet count, with repletion of iron levels helping to restore platelet levels. Heme iron, which is found in animal-based foods like red meat, poultry, and seafood, is more easily absorbed by the body. You can increase the absorption of nonheme iron in plant sources such as legumes, fortified cereals, spinach, kale, and dried fruits by combining them with a source of vitamin C such as citrus fruit, bell peppers, and broccoli.
Some studies suggest that certain foods and products can decrease your platelet counts and should be avoided by those with thrombocytopenia. Dairy products from cow’s milk may contribute to thrombocytopenia by interfering with platelet production. In addition, quinine, which is found in tonic water and cranberry juice, can lower platelet counts.
Future Directions and the Promise of Personalized Care
Mesenchymal stem cell therapy (MSC) is increasingly being used to address a variety of diseases, including autoimmune conditions. The stem cells are multipotent stromal cells or mesenchymal stromal cells that are found in multiple tissues.
Emerging research suggests that impaired bone marrow mesenchymal stem cells play an important role in the development of ITP, urging research into addressing this disease process using MSCs. Studies have found that MSC is effective at increasing platelet counts within a short period of time and achieving clinical remission of ITP.
Another emerging direction for addressing certain types of thrombocytopenia is gene therapy. The genetic condition Wiskott-Aldrich syndrome results in an immunodeficiency accompanied by microthrombocytopenia, autoimmunity, and eczema. While hematopoietic stem cell transplantation (HSCT) from an HLA-identical donor is currently used for the treatment of these patients, it has limited availability and significant morbidity and mortality. Emerging studies show that lentiviral gene therapy offers promise for restoring platelet size and function in these patients.
While IVIg is often used as an emergency treatment for those with ITP who need to undergo surgery or a medical procedure, it requires pooling antibodies from thousands of human donors. A new technique is in development to make a recombinant protein in the laboratory that mimics the effect of IVIg without relying on human blood products.
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Summary
You need enough platelets in your blood to help it clot and stop bleeding. If the number of platelets in your body drops too low, you can develop easy bleeding, bruising, and fatigue that indicates you have thrombocytopenia.
Blood testing can measure the amount of platelets in your body as well as evaluate potential reasons your platelets are too low, such as autoimmune diseases, cirrhosis of the liver, or nutrient deficiencies. Embracing modern diagnostics and therapies for optimal platelet health provides a more individualized and precise approach that targets our increasing understanding of the various pathophysiological processes underlying low platelets.
An integrative medicine approach develops an individualized plan to help restore platelets to an average level using diet and nutrition, supplementation, and lifestyle changes. Early and regular monitoring with functional medicine laboratory testing helps to provide recognition of issues to take a proactive approach. It also allows for targeted management that addresses body imbalances and root causes of thrombocytopenia.
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