Low Platelet Counts: When to Seek Further Testing

Thrombocytopenia

Hello Doctor, my mother has had a long-standing issue with low platelet counts.
A few years ago, she visited a hematology-oncology specialist, and her platelet count (PL) was around 70,000 to 80,000.
The specialist only recommended that she continue to monitor her condition with regular blood tests every 3 to 6 months.
After a while, she stopped going to the hospital for follow-ups.
Recently, she went for another check-up, and her PL is still 81,000.
However, I noticed that in the report, besides the low PL, the values for PDW (21.4), MPV (13.5), and P-LCR (54.9) are all above the standard range.
I would like to ask if it is necessary to take her for further immunological testing? Thank you!

Zhang Tai Tai, 40~49 year old female. Ask Date: 2021/06/25

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your message.
Generally, before a hematologist recommends continued monitoring for an elderly woman, they will also evaluate the screening indicators for immune function.
You may want to ask your physician whether there is a possibility of an immune issue for her; the physician should explain their thoughts and whether any previous tests have been conducted.
If you have concerns, my recommendations are as follows: 1.
A platelet count between 70,000 and 80,000 is unlikely to have any impact on the body, unless major surgery requiring anesthesia is planned.
This platelet level will not affect wound hemostasis, and no special treatment is necessary; just continue monitoring and be aware of any potential disease development.
2.
The values you provided indicate that the platelets vary in size (PDW), and the average size of platelets in the blood is larger (MPC, P-LCR).
There may be underlying reasons for this, including abnormalities in immune function or hematopoiesis, which could warrant further investigation of immune function.
If the elderly woman is over 70 years old, the likelihood of immune diseases is significantly lower, while the chances of hematopoietic dysfunction or other diseases may increase.
This is for your reference.
Best regards from the Department of Allergy, Immunology, and Rheumatology at Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2021/06/25

More Info

Understanding low platelet counts, or thrombocytopenia, is crucial for managing health effectively, especially when it has been a long-standing issue, as in your mother's case. Platelet counts below the normal range (typically 150,000 to 450,000 platelets per microliter of blood) can lead to various complications, including an increased risk of bleeding and bruising.
Your mother's platelet count of 81,000 is indeed low, and the additional parameters you mentioned—PDW (Platelet Distribution Width), MPV (Mean Platelet Volume), and P-LCR (Platelet Large Cell Ratio)—are also noteworthy. Elevated PDW and MPV can indicate that the bone marrow is producing larger and potentially more reactive platelets, which can occur in various conditions, including immune disorders, bone marrow disorders, or as a response to certain types of anemia. The P-LCR being high suggests that a significant proportion of her platelets are larger than average, which can also be a sign of increased platelet turnover or a compensatory response to low platelet counts.

Given that your mother has a history of low platelet counts and that her recent tests show not only low PL but also elevated PDW, MPV, and P-LCR, it would be prudent to consider further evaluation. While the hematologist previously recommended regular monitoring, the persistence of low platelet counts along with these additional abnormalities may warrant a more in-depth investigation into potential underlying causes.
In particular, it may be beneficial to consult with a hematologist again, especially one who specializes in thrombocytopenia or related disorders. They might suggest additional tests, such as:
1. Bone Marrow Biopsy: This can help determine if the bone marrow is producing platelets adequately and if there are any abnormalities in the marrow itself.

2. Autoimmune Testing: Since you mentioned the possibility of immune-related issues, tests for autoimmune conditions (like lupus or immune thrombocytopenic purpura) could be relevant.

3. Viral Infections: Certain viral infections can lead to low platelet counts, so tests for infections like hepatitis or HIV might be considered.

4. Nutritional Deficiencies: Assessing for deficiencies in vitamin B12, folate, or iron can also be important, as these can affect platelet production.

5. Coagulation Studies: These tests can help assess the blood's ability to clot and may provide insights into the cause of low platelet counts.

In terms of symptoms, while some individuals with low platelet counts may not experience noticeable issues, others might have symptoms such as easy bruising, prolonged bleeding from cuts, or petechiae (small red or purple spots on the skin). If your mother experiences any of these symptoms, it is even more critical to seek medical advice promptly.

In conclusion, while regular monitoring is essential, the combination of low platelet counts with elevated PDW, MPV, and P-LCR suggests that further investigation is warranted. Consulting with a hematologist for a comprehensive evaluation and potential additional testing would be a prudent step to ensure your mother's health is managed effectively.

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