Low Platelet Count in Elderly Patients: Risks and Treatments

The platelet count is 13,000?

My grandmother is 90 years old.
Recently, the doctor mentioned that her cardiac index is slightly elevated and there may be a possibility of coronary artery blockage, requiring catheterization.
If necessary, a stent might need to be placed during the procedure.
However, after the catheterization, the doctor indicated that the blockage in her heart was quite severe, approximately 90%, and her platelet count had dropped to only 50,000, making surgery impossible at that time.
She needs to be monitored and may require a blood transfusion to increase her platelet count.
This was about a week ago.
Since then, her platelet count has continued to decline, and today it is around 13,000.
She now feels nauseous after eating just a few bites of porridge, sleeps for longer periods, and has started to develop bruises and purple spots on her body.
Could her symptoms be due to her low platelet count? What should we be aware of, and are there any out-of-pocket medications available for her treatment? Additionally, what complications might arise from her current condition?

Sunzi, 20~29 year old female. Ask Date: 2018/03/24

Dr. He Dongjin reply Cardiology

Hello, if you are experiencing spontaneous bleeding, it is advisable to see a hematologist as soon as possible.
Changhua Hospital cares about your well-being.

Reply Date: 2018/03/24

More Info

Understanding low platelet count, particularly in elderly patients, is crucial due to the associated risks and potential complications. In your grandmother's case, her platelet count has dropped significantly to 13,000, which is alarmingly low and poses serious health risks, especially in the context of her existing cardiovascular issues.

Symptoms of Low Platelet Count
Low platelet counts, or thrombocytopenia, can lead to various symptoms, particularly an increased risk of bleeding. Common signs include:
1. Easy Bruising: The appearance of purple or red spots on the skin (petechiae) or larger bruises (ecchymosis) can occur even with minor trauma.

2. Prolonged Bleeding: Cuts may bleed longer than usual, and spontaneous bleeding can occur, such as nosebleeds or bleeding gums.

3. Fatigue and Weakness: As the body struggles to maintain normal functions, fatigue can become more pronounced.

4. Gastrointestinal Symptoms: Nausea and vomiting, as you mentioned, can occur, especially if there is internal bleeding.

5. Increased Sleepiness: This can be a sign of underlying issues, including anemia or other complications.

Risks and Complications
Given your grandmother's age and her low platelet count, there are several risks to consider:
- Spontaneous Bleeding: With a platelet count as low as 13,000, the risk of spontaneous bleeding increases significantly. This can lead to serious complications, including intracranial hemorrhage, which is life-threatening.

- Surgical Risks: If surgery is necessary, the low platelet count poses a significant risk for excessive bleeding during and after the procedure. This is why her doctors are cautious about proceeding with any surgical interventions until her platelet levels are stabilized.

- Infection Risk: If her low platelet count is due to bone marrow issues or other underlying conditions, there may also be a risk of infection, particularly if her white blood cell count is affected.

Treatment Options
1. Platelet Transfusion: Given her critically low platelet count, a platelet transfusion may be necessary to quickly increase her platelet levels and reduce the risk of bleeding. This is often the first line of treatment in acute situations.

2. Medications: There are medications available that can stimulate platelet production, such as romiplostim (Nplate) or eltrombopag (Promacta). These may be options to discuss with her healthcare provider, especially if her condition is chronic and not responding to other treatments.

3. Monitoring and Supportive Care: Close monitoring is essential. This includes regular blood tests to track her platelet levels and overall health. Supportive care, including hydration and nutrition, is also important.

4. Addressing Underlying Causes: If her low platelet count is due to an underlying condition (like an autoimmune disorder or bone marrow issue), treating that condition is crucial. This may involve immunosuppressive therapy or other targeted treatments.

Recommendations
- Immediate Medical Attention: Given her current symptoms and extremely low platelet count, it is critical to seek immediate medical attention. A hematologist should evaluate her condition to determine the best course of action.

- Avoiding Injuries: Take precautions to minimize the risk of injury. This includes avoiding activities that could lead to cuts or bruises and being cautious with movements.

- Discussing Treatment Options: Engage in a thorough discussion with her healthcare team about the potential for new medications or treatments that could help manage her condition.

In conclusion, your grandmother's situation is serious and requires prompt medical intervention. The risks associated with low platelet counts, especially in elderly patients, cannot be overstated. Close collaboration with her healthcare providers will be essential in managing her health and ensuring the best possible outcomes.

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