Low Platelet Counts: Concerns and Management for Seniors - Cardiology

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Low platelet count?


Dear Chief Physician,
My father is 66 years old and has been on medication for hypertension for four years.
Currently, he has a low platelet count, which is at 20,000.
He has been taking steroids for six months, during which his platelet count has fluctuated between 5,000 and 50,000.
His medical history includes an episode last August where he experienced a month of urinary issues, which was treated successfully.
In September, he had significant bleeding (1-2 liters) after having three teeth extracted, and after returning from a trip to Tibet, he felt exhausted and went to the hospital, where his platelet count was found to be only 5,000.
He has been on medication since then.
Recently, an ENT specialist discovered a bacterial infection in his mouth that has spread to his throat, and he is currently on antibiotics.
I have several questions:
1.
He has been on steroids for a long time and is now experiencing hoarseness, weakness, a moon face, and a hunched back.
He often complains of weakness in his lower limbs and has nerve pain in his back and hands.
Additionally, his limbs appear thinner, and his skin looks rough and dark.
Could these be side effects of the steroids? If his platelet count returns to normal, will these side effects resolve?
2.
He had a platelet count of 90,000 once, but two weeks later, it dropped to 20,000.
I suspect he may have stopped taking his medication without informing anyone.
Is it common for platelet counts to drop significantly if a patient stops their medication?
3.
My father has been taking medication for nearly six months and has reported significant stomach discomfort.
Initially, he took medication daily, but after discussing his discomfort with his doctor, he switched to taking it only four days every two weeks.
Is this dosage too strong, and will it still be effective?
4.
Could his low platelet count be a result of the significant bleeding from his periodontal disease? Is there a chance for improvement and recovery?
5.
My mother has been making chicken soup with a traditional herbal supplement for him daily for about two months.
In March, she discovered a lipoma in her breast, and the doctor advised that it does not need to be removed.
My father has been in a bad mood, suspecting that the soup is too nourishing, so my mother has switched to making bass fish soup daily.
Is it sufficient for my father’s diet to be balanced and complete? He seems to have aged ten years in the past six months, which is concerning.
I am married and caring for two young children, so I cannot fully follow up on my father's treatment process.
I would appreciate your advice on the above questions.
Thank you for your time and suggestions!

Kely, 30~39 year old female. Ask Date: 2013/03/20

Dr. He Dongjin reply Cardiology


Hello, your questions should be directed to a hematologist.
Based on my understanding: 1.
Bleeding is caused by low platelet counts rather than a decrease in platelets due to the recent tooth extraction.
2.
Corticosteroids should not be stopped abruptly, as fluctuations in drug concentration can be detrimental to your health.
3.
You are correct about the side effects of corticosteroids; however, once you recover and are advised to discontinue, the symptoms will gradually subside.
It is crucial not to avoid taking medication due to fear of side effects, as this may prolong the treatment duration.
4.
You may ask your physician to prescribe a better over-the-counter gastric medication, as corticosteroids can cause gastric discomfort.
5.
As far as I know, supplements do not have a significant effect at this time, and there are concerns about drug interactions affecting efficacy, so their use is not recommended.
A balanced and complete diet is sufficient.
Changhua Hospital cares about you.

Reply Date: 2013/03/20

More Info


Low platelet counts, or thrombocytopenia, can be a significant concern, especially in older adults. Your father's situation, with a platelet count fluctuating between 5,000 and 50,000, is particularly alarming and requires careful management. Here’s a comprehensive overview addressing your questions and concerns.


1. Side Effects of Long-term Steroid Use
Long-term use of corticosteroids can lead to a variety of side effects, including the symptoms your father is experiencing: voice changes (hoarseness), moon facies (facial swelling), back pain, muscle weakness, and skin changes. These symptoms are indeed consistent with steroid side effects, which can include:
- Cushing's Syndrome: Characterized by weight gain, fat redistribution, and skin changes.

- Muscle Atrophy: Prolonged steroid use can lead to muscle weakness and atrophy, especially in the limbs.

- Osteoporosis: Steroids can weaken bones, leading to back pain and increased fracture risk.

- Gastrointestinal Issues: Steroids can irritate the stomach lining, leading to discomfort or ulcers.

If platelet counts normalize, some of these side effects may improve, but it is crucial to manage steroid use carefully under a physician's guidance, as abrupt discontinuation can lead to adrenal insufficiency.


2. Fluctuating Platelet Counts
The significant drop in platelet counts could be due to various factors, including the underlying condition causing thrombocytopenia, medication adherence, or even the effects of the steroids themselves. If your father is suspected of not taking his medication as prescribed, it is essential to have an open discussion with him about the importance of consistent medication adherence. Regular follow-ups with his healthcare provider can help monitor his condition and adjust treatment as necessary.


3. Medication Dosage and Frequency
Changing the frequency of steroid administration from daily to every other week can affect the medication's efficacy. Steroids are typically dosed to maintain a therapeutic level in the bloodstream. If your father is experiencing gastrointestinal discomfort, it may be beneficial to discuss alternative medications or adjunct therapies with his doctor. The goal is to find a balance that manages his platelet count while minimizing side effects.


4. Connection Between Dental Issues and Platelet Count
Your father’s history of significant bleeding during dental procedures could indeed be related to his low platelet count. Thrombocytopenia can lead to increased bleeding tendencies, especially in situations where blood clotting is crucial, such as after dental extractions. Improving his platelet count through appropriate medical management may help reduce the risk of similar incidents in the future.


5. Nutritional Considerations
Diet plays a crucial role in overall health, particularly for someone with low platelet counts. A balanced diet rich in vitamins and minerals can support blood health. While there is no specific "cure" diet for thrombocytopenia, ensuring adequate intake of:
- Vitamin B12 and Folate: These are essential for blood cell production.

- Iron: Important for overall blood health.

- Omega-3 Fatty Acids: Found in fish, these can help reduce inflammation.

Your mother’s switch from chicken soup to fish soup is a good idea, as fish provides healthy fats and protein. However, it’s essential to maintain a varied diet that includes fruits, vegetables, whole grains, and lean proteins.


Conclusion
Your father's health concerns are multifaceted, and managing low platelet counts requires a comprehensive approach involving medication management, dietary considerations, and regular medical follow-ups. It’s crucial to maintain open communication with his healthcare team to ensure that all aspects of his health are being monitored and addressed. Encourage your father to adhere to his treatment plan and discuss any side effects or concerns with his doctor to optimize his care.

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