Thrombocytopenia is a condition that occurs when there is a low level of platelets in the blood. Platelets are tiny, disc-shaped cells produced in the bone marrow that are essential for blood clotting. When a blood vessel is injured, platelets rush to the site of the injury and clump together to form a clot, which helps to stop bleeding.
Adult platelet counts typically range from 150,000 to 450,000 per microliter of blood. Thrombocytopenia is defined as a platelet count of fewer than 150,000 per microliter.
ICD-10 Code for Thrombocytopenia
The ICD-10 code for thrombocytopenia depends on whether the cause is known or unknown. Here’s a breakdown of the relevant codes:
- D69.6: Thrombocytopenia, unspecified: This is the code used when the cause of the low platelet count is unknown.
- D69.3: Immune thrombocytopenic purpura (ITP): This code is used for a specific autoimmune disorder that causes thrombocytopenia.
- D69.4: Other primary thrombocytopenia: This code applies to other primary thrombocytopenias, which are those that arise from problems with platelet production in the bone marrow.
- D69.5: Secondary thrombocytopenia: This code is used when thrombocytopenia is caused by another underlying condition, such as infection, medication, or splenomegaly.
Causes of Thrombocytopenia
There are several causes of thrombocytopenia, which can be broadly classified into three categories:
- Decreased platelet production: This can be caused by bone marrow problems, such as leukemia, lymphoma, aplastic anemia, or myelodysplasia.
- Increased platelet destruction: This can be caused by immune system problems, such as idiopathic thrombocytopenic purpura (ITP) or heparin-induced thrombocytopenia (HIT), or by infections, such as sepsis or dengue fever.
- Spleen enlargement: An enlarged spleen can trap platelets, reducing the number of platelets in circulation. This can be caused by liver disease, infections, or tumors.
Other causes of thrombocytopenia include:
- Viral diseases such Epstein-Barr virus, hepatitis C, and HIV
- Bacterial infections
- Medications like quinine, heparin, or chemotherapeutic medications
- Pregnancy
- Vitamin deficits, like a folate or vitamin B12 insufficiency
- Alcohol abuse
Symptoms of Thrombocytopenia
Thrombocytopenia often causes no symptoms, especially in mild cases. On the other hand, if your platelet count is really low, you might:
- Easy or excessive bruising
- Petechiae, which are tiny, flat, red or purple spots on the skin caused by bleeding from small blood vessels
- Purpura, which are larger purple bruises
- Bleeding from the gums or nose
- Blood in your urine or stool
- Heavy menstrual periods
- Prolonged bleeding from cuts
Diagnosis of Thrombocytopenia
Thrombocytopenia is usually diagnosed with a complete blood count (CBC), which is a routine blood test that measures the number of different types of blood cells in your blood. A low platelet count on a CBC is the first indication of thrombocytopenia.
Your doctor may also order additional tests to determine the cause of your low platelet count, such as:
- Blood tests to check for infections or autoimmune diseases
- Bone marrow aspiration and biopsy to examine the bone marrow for abnormalities
- Imaging tests, such as an ultrasound of your spleen, to check for an enlarged spleen
Complications of Thrombocytopenia
Thrombocytopenia itself isn’t necessarily a life-threatening condition. However, the major concern is the increased risk of bleeding that comes with it. The severity of bleeding complications depends on the degree of thrombocytopenia.
- Easy bruising and bleeding: This is the most common complication of thrombocytopenia. People with thrombocytopenia bruise easily and may bleed for a longer time after minor injuries like cuts or scrapes.
- Petechiae and purpura: Petechiae are tiny, flat red or purple spots under the skin caused by bleeding from small blood vessels. Purpura are larger purple bruises. These can appear anywhere on the body but are commonly seen on the legs.
- Bleeding from mucous membranes: This includes nosebleeds, bleeding gums, blood in the stool (hematochezia), or blood in the urine (hematuria).
- Internal bleeding: In severe cases of thrombocytopenia, there’s a risk of serious internal bleeding. This can occur in the gastrointestinal tract, brain, or other organs. Internal bleeding can be life-threatening.
Here are some factors that can increase the risk of bleeding in people with thrombocytopenia:
- Trauma or injury
- Surgery
- Certain medications that interfere with platelet function, such as aspirin, blood thinners, and some nonsteroidal anti-inflammatory drugs (NSAIDs)
- Alcohol use
- Having a medical condition that affects blood clotting, such as liver disease or uremia
Treatment Options for Thrombocytopenia
There are a number of treatment options for thrombocytopenia, depending on the underlying cause of the condition. The following are a few of the most common treatments:
- Medications:
- Corticosteroids: These medications can help suppress the immune system and reduce platelet destruction.
- Intravenous immune globulin (IVIG): This is a blood product that contains antibodies from healthy people. It can help to block the immune system from destroying platelets.
- Thrombopoietin receptor agonists (TPO-RAs): These medications stimulate the production of platelets by the bone marrow.
- Immunosuppressant medications: These medications can be used to suppress the immune system in more severe cases of thrombocytopenia.
- Blood transfusions: If your platelet count is very low and you are at risk of bleeding, you may need a platelet transfusion. This will increase your platelet count and help to stop bleeding.
- Surgery: In some cases, surgery to remove the spleen (splenectomy) may be recommended. The spleen is the organ that stores platelets, and sometimes it can destroy platelets in people with thrombocytopenia.
- Treating the underlying cause: If your thrombocytopenia is caused by another medical condition, such as an infection or medication, treating that condition may help to improve your platelet count.
It is important to note that this is not an exhaustive list of treatment options for thrombocytopenia. The best treatment for you will depend on the underlying cause of your condition, as well as your overall health.
Here are some additional things to keep in mind about treatment for thrombocytopenia:
- Treatment may not be necessary for everyone with thrombocytopenia. If your platelet count is mildly low and you are not at risk of bleeding, your doctor may recommend monitoring your condition.
- Treatment can have side effects. It is important to discuss the risks and benefits of treatment with your doctor.
- Treatment may not cure thrombocytopenia, but it can help to control the condition and reduce your risk of bleeding.