Pediatric Low Platelet Counts: When to Seek Further Testing

Further inquiry regarding platelet count?

Hello Dr.
Pei, thank you for your response to my question.
Actually, my child's school conducted a health check with a hospital last semester, and on October 4, 2023, the platelet count from the blood test was 125 (the hospital's reference range is 120-400), so the report was considered normal and no further follow-up was done.
Later, in the next semester, another hospital conducted a health check, and on March 20, 2024, the platelet count was 128 (the hospital's reference range is 150-400), which revealed the abnormality.
The recent two values are as mentioned above.
I would like to consult you again, Dr.
Pei, thank you very much.
My child is a 13-year-old boy currently in the first year of junior high school, and during a blood test at school, the platelet count was found to be abnormal, with a reference range of 150-400, and the child's count is 128.
Should this value be further investigated? Which specialty should we consult?
Dr.
Ren-Sheng Pei from Taoyuan Hospital, Pediatrics, replied on May 9, 2024: Hello, the standard for low platelet count is less than 150,000.
A count of 128,000 is indeed slightly low; however, a platelet count below 20,000 would lead to functional insufficiency and spontaneous bleeding.
I recommend repeating the blood test in 2-4 weeks.
As long as the count does not continue to decline, there is no need for concern.
Wishing you good health! Sincerely, Ren-Sheng.

ching, 40~49 year old female. Ask Date: 2024/05/09

Dr. Pei Rensheng reply Pediatrics

Hello! After about six months, the platelet levels have not fluctuated much; they are far from the danger zone, so there is no need for concern or to deliberately have more blood drawn.
Just pay attention to any signs of bleeding tendencies, such as frequent nosebleeds, or subcutaneous bleeding/bruising.
Wishing everyone health and safety! Sincerely, Ren Sheng.

Reply Date: 2024/05/09

More Info

Understanding pediatric low platelet counts, particularly in the context of Immune Thrombocytopenic Purpura (ITP), is crucial for parents and caregivers. In your case, your child has been diagnosed with ITP, which is characterized by low platelet counts, and you are understandably concerned about the implications of this condition and the treatment options available.

ITP is an autoimmune disorder where the immune system mistakenly attacks and destroys platelets, leading to thrombocytopenia (low platelet counts). In children, ITP often resolves spontaneously, especially if it occurs after a viral infection. However, in some cases, it can persist, as seen in your child's situation where the platelet count has remained low for over a year.

The use of treatments like Romiplostim (brand name Nplate), which is a thrombopoietin receptor agonist, can stimulate the bone marrow to produce more platelets. While you mentioned that the initial response to Romiplostim was positive, with platelet counts exceeding 100,000, the subsequent decrease in platelet levels is concerning. It's essential to monitor these counts closely, as fluctuations can occur in ITP patients.

Regarding your question about whether children with ITP can eventually recover normal platelet counts as they grow older, the answer is yes, many children do experience a resolution of their condition. Studies have shown that a significant percentage of children with ITP will have their platelet counts return to normal without any treatment, particularly those diagnosed at a younger age. However, the prognosis can vary based on individual circumstances, including the severity of the condition and the response to treatment.

The need for further testing, such as a bone marrow biopsy, is typically considered when there is a concern for other underlying conditions that might be causing the low platelet counts. Since your child's bone marrow was previously assessed and found to be normal, this may not be necessary unless there are new symptoms or significant changes in blood counts. The physician may want to rule out other causes of thrombocytopenia, such as bone marrow disorders or other hematological conditions.

As for the chromosome testing, it is generally sufficient to perform it once unless there are specific indications to repeat it. Chromosomal abnormalities can sometimes be associated with blood disorders, but if the initial tests were normal, the likelihood of needing a repeat test is low.

In conclusion, while your child's platelet count is slightly below the normal range, it is not critically low, and immediate intervention may not be necessary. Regular monitoring and follow-up with a pediatric hematologist are essential to ensure that any changes in the platelet count are addressed promptly. If the platelet counts remain stable or improve, it may indicate a favorable prognosis. Always feel free to discuss any concerns with your healthcare provider, as they can provide personalized guidance based on your child's specific situation.

Similar Q&A

Understanding Low Platelet Counts in Children: When to Seek Further Testing

Hello Dr. Pei, my son is currently in the first year of junior high school (13 years old). He had a blood test at school that showed abnormal platelet levels, with a reference range of 150-400, and his result was 128. Should this value be further investigated? Which specialty sho...

Dr. Pei Rensheng reply Pediatrics
Hello: The standard for thrombocytopenia is less than 150,000 platelets, and 128,000 is indeed slightly low; however, a platelet count below 20,000 is when functional insufficiency occurs, leading to spontaneous bleeding. It is recommended to have a follow-up blood test in 2-4 we...

Understanding Low Platelet Counts in Children: Causes and Concerns

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...

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 unu...

High Platelet Count in Children: When to Seek Further Medical Evaluation?

Hello Doctor: My child (in the first year of junior high) received a health check-up form from school yesterday. All the indices are normal, but the platelet count is 465, and there is +++ for urine occult blood. Should we go to the hospital for further examination? Should we see...

Dr. Hu Ziren reply Oncology
Platelets themselves are also inflammatory mediators. If there is inflammation or infection (such as a cold, etc.) in the body on the day of blood draw or within a few days, platelet levels may temporarily increase. A. It is recommended to follow up in 3-6 months; if levels remai...

Understanding Pediatric ITP: Low Platelet Counts and Treatment Options

Hello Dr. Hsiao: A family member's child has been diagnosed with ITP for a year. Bone marrow tests have confirmed normal results, and blood cell counts are normal, with only extremely low platelet counts (ranging from 20,000 to 70,000, occasionally exceeding 100,000). The ...

Dr. Xiao Kaiwen reply Pediatrics
I apologize, but the question you are asking pertains to a very specialized field (pediatric hematology-oncology). I am not a physician in this specialty and do not have the academic training to provide an appropriate answer. I can only suggest that family members should collabor...