When low platelets lead to a transfusion

Call 911 for bleeding you cannot stop, for a severe headache, or for confusion or drowsiness that is new. NCI singles out changes in vision, severe headaches, confusion and drowsiness as serious warning signs when platelets are low, and heavy uncontrolled bleeding is an emergency in its own right.

Call your care team the same day for bleeding that lasts more than a few minutes after pressing on it, for blood in your urine or stool, for bleeding from the mouth or nose, for blood in vomit, for unusually heavy menstrual bleeding, or for a spread of tiny purple or red spots on your skin.

If you are bleeding while you wait, NCI says to press down firmly on the area with a clean cloth until it stops.

Platelets are the part of blood that plugs leaks. NCI describes them as the cells that help your blood to clot and stop bleeding. A shortage of them is called thrombocytopenia.

NHLBI explains where cancer comes in. Cancers such as leukaemia or lymphoma can damage bone marrow. Cancer treatments do too. Radiation and chemotherapy destroy the stem cells that blood cells grow from. Fewer stem cells means fewer platelets are made.

That is why platelet counts are checked so often during treatment. The number moves. The team is tracking where in the cycle it dips.

Often it feels like nothing at all. Low platelets usually show up on a blood test before the person notices a thing.

When there are signs, NCI and NHLBI describe much the same ones:

• Bruising more easily than usual
• Tiny purple or red spots on the skin
• Nosebleeds, or bleeding from the gums
• Blood in urine or stool
• Bleeding that goes on a long time, even from small injuries
• Heavier than usual menstrual bleeding

A bruise you cannot explain is worth mentioning. A bruise plus any of the bleeding above is worth mentioning today.

Here is what people most often get wrong. A low number on a printout does not automatically mean a bag of platelets.

NHLBI is specific about treatment. Blood or platelet transfusions are used to treat people who are bleeding heavily or who are at high risk of bleeding. It lists other options too. Those include corticosteroids such as prednisone. They also include medicines that boost platelet production, such as eltrombopag and romiplostim. NHLBI notes that removing the spleen may raise counts in some situations.

Which option applies depends on two things. Why the platelets are low, and what is actually happening to the patient. No universal cut-off is published here. Be sceptical of anyone who quotes you one without knowing your case. Ask your own team what threshold they work to, and why.

NCI's practical tips for a low-platelet period are simple. They are worth adopting:

• Avoid over-the-counter medicines with aspirin or ibuprofen, unless your team says otherwise.
• Use a soft toothbrush.
• Shave with an electric shaver rather than a blade.
• Wear shoes indoors as well as out.
• Put ice on bruises.

Ask before you add anything else, supplements included. Plenty of ordinary products affect clotting. And tell your team about any change you notice. That is the standard NCI itself sets. Patients should alert their provider about changes they notice.