Low Platelet Counts in Children: Causes and Concerns - Pediatrics

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Low platelet count?


Hello, doctor.
My child has been hospitalized a few times in the past.
In 2018, the platelet counts were normal, with the first hospitalization showing a count of 191 and the second hospitalization showing a count of 163 (both occurred one month apart and were due to vomiting and diarrhea).
However, over the past two years, my child's platelet counts have been low each time blood tests were done during periods of illness.
In early 2019, during a hospitalization for gastroenteritis, the platelet count was 129 (with fever and vomiting).
At the end of 2019, during a hospitalization for influenza, the count was 145 (with fever).
In August 2020, during another hospitalization for gastroenteritis, the count was 154, and before discharge, it was 149 (with low-grade fever, vomiting, and diarrhea).

I would like to ask the doctor if platelet counts can be low during periods of illness or abnormal eating (such as during gastroenteritis when the child eats very little and only bland foods).
My child is usually very active and often has bruises on both legs, but there are fewer bruises on other parts of the body.
The bruises tend to be larger rather than small spots.
If there is a period with less jumping and bumping, the bruising also noticeably decreases.
Previously, the doctors did not mention this issue upon discharge, but this year, a different doctor noted that my child's platelet count was low and advised us to pay attention to it.
Therefore, I have reviewed the recent blood test reports and am concerned that my child may have thrombocytopenia (low platelet count) or a bleeding disorder (purpura).

Yú er, 0~9 year old female. Ask Date: 2020/09/01

Dr. Xiao Kaiwen reply Pediatrics


Generally, common illnesses do not cause thrombocytopenia unless they are specific, rare, and severe diseases.
A platelet count above 100,000 is considered normal, while thrombocytopenia (purpura) is defined as a platelet count below 20,000.
It is important to monitor for any unusual bruising or purpura, bleeding from the gums, or abnormal bleeding such as black stools or blood in urine.
If none of these symptoms are present, a follow-up platelet count can be done every 3 to 6 months.

Reply Date: 2020/09/01

More Info


Understanding low platelet counts in children can be a complex issue, especially when considering the various factors that can influence these counts. In your child's case, it appears that there have been several instances of low platelet counts during periods of illness, particularly during episodes of gastroenteritis and influenza.
Firstly, it is important to note that a low platelet count, or thrombocytopenia, can occur for a variety of reasons. In children, common causes include infections, immune system disorders, and bone marrow issues. In your child's case, the low platelet counts during illness may be related to the body's response to infection. When a child is ill, particularly with viral infections, the body can produce antibodies that inadvertently target and destroy platelets, leading to a temporary decrease in platelet counts. This phenomenon is often seen in conditions like Immune Thrombocytopenic Purpura (ITP), where the immune system mistakenly attacks platelets.

Regarding your question about whether low platelet counts can occur during periods of discomfort or poor dietary intake, the answer is somewhat nuanced. While general illness and stress on the body can lead to fluctuations in platelet counts, it is not typical for mild illnesses or dietary changes alone to cause significant drops in platelet levels. However, severe infections or prolonged illnesses can lead to lower counts. Additionally, during episodes of vomiting and diarrhea, as seen in gastroenteritis, dehydration and nutritional deficiencies can also play a role in affecting overall blood counts, including platelets.

Your observations about your child's tendency to bruise easily are also relevant. Bruising can occur when platelet counts are low, as platelets are crucial for blood clotting. However, the fact that your child has bruised primarily on the legs and not elsewhere, and that the bruising varies with activity levels, suggests that there may be other factors at play, such as physical activity and minor injuries that are more likely to occur during play.

It is also important to consider the threshold for concern regarding platelet counts. A platelet count above 100,000 per microliter is generally considered safe, while counts below 20,000 can pose a risk for spontaneous bleeding. Your child's counts, while lower than normal, have not dropped to critically low levels in the instances you've provided, which is reassuring.

In terms of monitoring and follow-up, it is advisable to keep track of your child's platelet counts, especially during and after illnesses. Regular check-ups with a pediatric hematologist may be warranted if low counts persist or if there are additional symptoms, such as unusual bruising, bleeding gums, or blood in urine or stool. These could indicate a more serious underlying condition that may require further investigation.

Finally, while it is understandable to be concerned about conditions like ITP or other forms of thrombocytopenia, it is crucial to work closely with your child's healthcare providers. They can offer tailored advice based on your child's specific medical history and current health status. If there are any significant changes in your child's health or platelet counts, do not hesitate to seek medical advice promptly.

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