Expert: Neha Dahiya MD - 10/27/2009

Question
I'm trying to come to the bottom of a bit of a mystery.  My platelets keep coming back quite low and in looking over my deceased daughter's labs I keep wondering what I might have passed onto her that could have attributed to her death.

At birth, notable is that MCHC is low and RDW is slightly high.  The automated differential however is where it's quite noticeable:  her seg % is extremely high [15.0-35.0] and hers was 64.3 then 56.4 the next day.  The lymph % was quite ridiculously low:  [41.0-71.0] and hers tested 23.3 then 29.8 before she left the hospital.

I bruise very easily and I'm tired all the time, so I had a CBC taken and my platelets apparently have been low for years.  I've checked back and every single blood test (I've had about 6 in the past 3 years) shows platelets low - before periods very low.

When my daughter died she had low platelets [150-400] and her number was 66!  I'm guessing WBC was high because she'd received her vaccinations and was fighting off appropriately the infections to become immune.  RBC, HGB, HCT and PLT were all low.

Red blood cell [3.10-4.50] = 1.31
hemoglobin [9.5-13.5] = 3.5
hematocrit [29.0-41.0] = 11.4
platelets [150-400] = 66

She was bleeding by the time she got to this hospital and it was suggested that trauma was indicative of this type of bleeding, but I'm wondering if this is a case of which came first the chicken or the egg?  Was she perhaps in a spot which would have caused her to bleed more readily or bruise, etc?  

I happen to bruise exceedly easily.  So do most of the women in my family (older sister and mother included).

I really believe that these numbers have a story to tell and I'd very much like to get to the bottom of this.  Thank you for any help you can provide.

Answer
Hello Tonya:

The ideal person to help you with this situation will be a hematologist...a person which deals with disorders of blood. I am not an expert here but will try and give some answers.

When blood platelets fall below normal range (150,000 to 450,000/microliter of blood)the condition is called thrombocytopenia.

Complications due to low platelet count can be none to severe bleeding. The risk is maximum when the platelets fall below 10,000 as it leads to bleeding in internal organs.

causes of thrombocytopenia can fall under one of teh three categories:
1) Reduced production of platelets: platelets are formed in the bone marrow and various conditions affect the bone marrow leading to reduced production....viral infections including HIV, cancers affecting the marrow, leukemia some types of anemia etc
2)Increased breakdown of platelets: This is seen in pregnancy, blood poisoning, ITP - a type of disease where body does not recognize its own platelets and destroys them and other immune mediated diseases etc
3)Trapping of platelets by spleen: Spleen is an organ just below the rib cage and this filters blood of unwanted substances. This can be enlarged due to a number of diseases and then traps platelets leading to their decrease in circulation.

So any number of causes can lead to decreased platelets. In your daughter's case the platelets are definitely low but it is difficult to say what is the cause unless a detailed history is known with all other kinds of tests which were done. The RBC , hemoglobin and hematite become low when a person bleeds a lot.

Easy bruising is seen in most women mostly attributed to fragility of the blood vessels in women. However low platelet counts can lead to bruising too. The causes are complex and a detailed examination needs to be done to arrive at a final diagnosis.

I hope this helps to some extent