I met a patient presented with relapsing remitting fever. On investigation his platelet count was 500 only with low RBC and WBC count. on further testing he found to have Aplastic anemia.
Dear Arshad,
I am not quite sure what you mean by minimum platelet count. There multiple aspects to consider when relating the platelet count to bleeding complication. However, to make things a bit less confusing I outlined some off the most frequent to be considered. When you assume a direct relation between platelet count and bleeding complications than no other additional plalelet or coagulation factor complication should be present. Furthermore, there are also multiple acquired factors that influence the platelet functions, such as aspirine and stress. These should also be excluded. Finally, from my own experience with Chronolog platelet measurements, I can say that there two patients with equal amounts of platelet dont always show the same curve. Moreover, even the same patient over time shows differences in curves. Therefore we always advice to measure twice. So, chronolog measurement, which are the gold standard, reveal differences within and between patients at the same platelet count. In addition, the amount needed to get a measurable single on the chronolog also differs between patients, with a thresshold of about 100/150 x 109. In conclusion, it remains difficult to give an exact answer to your question. However, when excluding several of the above questions you may get a better picture of the relation between platelet count and bleeding tendency. However, such a relation may well be patient sensitive.
Best,
René
Daer Arshad
Regarding Your question, It would be reasonable to clarify the units, since You are mentioning "500" platelets. Generally used units are reported as platelet count x 10e9.
Dear Arshad,
Please refer to the following article
Transfus Med Rev. 2004 Jul;18(3):153-67.
Relationship between platelet count and bleeding risk in thrombocytopenic patients.
Slichter SJ1.
"In a large retrospective study, the most significant predictor of bleeding was not the patient's platelet count but a history of bleeding in the prior 5 days".
The platelet count and the risk of bleeding could be variable from patient to patient and hence it may be difficult to suggest a number which could be applicable to different patients who are at risk of bleeding.
Omer
In leukemic patients, who are the best studied for this purpose, a platelet count of 10,000 or less is associated with a significant enough risk of bleeding to permit prophylactic platelet transfusion. Measuring platelet counts under 10,000 is difficult to do with accuracy.
Our experience provides the following guide PATIENTS
Initial management
In recent illness, the goal is to reach a certain count as soon as possible to avoid severe bleeding (CNS) or fatal. In chronic disease, the goal is to keep a count> 30x109 / L (> 50 x109 / L in elderly or additional risk factors). Treatment should be considered in those with
Hello peter Kubisz thanks for query. his platelet count was 500 cubic mm.
Mr Rune mulder I know that bleeding depends on multiple factors in addition to platelet count, but even if there is no other factors are there, this much low level of platelet count might produce bleeding anywhere in the body.
The minimun platelet count required to maintain endothelial integrity is 5000/ul. I read this in a paper by Slichter on platelet transfusion dose. In fact there is a trend to transfuse prophylactically platelets under that number (instead the usual 10.000), in a non bleeding and without fever patient. As you said it also depends on intact platelet aggregation and adhesion and maintaining the hematocrit above 25% so as to be a source of ADP for platelets fo function correctly.
Well, it depends. All the answers above are very informative. I ran a a special coag lab for years (no longer doing it). It depends on the number of platelets as well as sthe size of platelets. Platelets come from the cytoplasm of megakaryocytes, and break up in larger chunks that then break down into smaller and smaller chunks. Kind of like safety glass. Larger platelets function much better than smaller platelets. Patients with diseases that demand a fast turnover of platelets have very large platelets, as determined by MPV (Mean Platelet Volume). I have seen patients with ITP walking the street and participitating ins sports with platelets of 11K! (normal >150K). This is because their platelets are very large and make up in size for the low numbers. They eventually present with some unexplained bleeeding and this is how diagnosis is made.
Now, "bleeding" is a vague word, believe it or not. We are always popping little holes in vessels that get immediately plugged by "passing platelets". and we never know about it. This start becoming visible when the platelet counts start dropping. Then little bleeding spots will appear in the skin. this is known as "petechiae".
So, being director of Trasnsfusion Mecidine, here is a brief summary based on my experience and also literature.P
Platelet count >100 no problem, can get even liver transplant
Platelet count coagulation tests start being prolonged
Platelet count
addendum to my initial anwer.
Patients who have a platelet count less than 50K and need a procedure, are OK to receive platelets. 1 Single donor platelet at a time and check a plt count afterwards. If he needs more to reach 50K, then transfuse another unit until the goal is reached
Remember: "ALL BLEEDING WILL EVENTUALLY STOP!'
the optimum count for patient with no bleeding is 50 K, but when operative intervention the count must be increased just befor surgery to avoid intraoperative bleeding, some doctors prefare the count reach from 100 to 150 K.
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