Low Platelet Count (Bleeding)

Platelets are blood cells called thrombocytes and help your blood clot, so you stop bleeding. Low platelet count is also called thrombocytopenia. When your platelet levels are lower than normal, your blood isn’t able to clot as it should, putting you at a higher risk for excessive bleeding. The lower your platelet count, the higher your risk for bleeding. Your doctor will tell you what level is considered a low platelet count. If you have a very low platelet count, sometimes your doctor will delay your treatment or reduce your dose. Your doctor will use a blood test called a complete blood count (CBC) to measure your platelet level

Causes of low platelet count

Your platelet count may be low if the body is not making enough platelets, losing platelets, or platelets are being destroyed. In patients with cancer, low platelet count may be caused by:

  • Certain types of cancer: patients with lymphomas or leukemias may be at higher risk for low platelet counts
  • Certain types or cancer treatment, such as chemotherapy or radiation therapy that is used in large amounts or in combination with chemotherapy
  • Sometimes the proteins in your body called antibodies may attack and destroy platelets
  • Another health problem or medication that is not related to your cancer

Symptoms of low platelet count

If your platelet levels drop, you may begin to notice one or more of these symptoms

  • Bleeding from anywhere (such as the mouth, nose, or rectum)
  • Bloody or dark brown spit or vomit
  • Bright red, dark red, or black stools
  • Red, pink, or brown urine
  • Women may have heavy vaginal bleeding during monthly periods
  • New unexplained bruises on the skin
  • Red pinpoint dots on the skin, usually starting on feet and legs
  • Bad headaches, dizziness, or blurred vision
  • Weakness that gets worse
  • Pain in joints or muscles

Call your cancer care team right away if you notice any of these symptoms.

Platelet transfusion in patients with low platelet counts

A platelet transfusion might be needed in some patients with cancer who have a low platelet count. Platelets may be given to prevent bleeding when the platelet count is very low, or they may be given if a patient has some unusual bleeding to help stop it.

Before platelets are given, the donor is carefully matched to the patient and the platelets are screened so they are safe. But, receiving a platelet transfusion has some risks:

  • Transfusion reaction: This happens when the patient’s immune system attacks proteins on the foreign blood cells. This often looks like an allergic reaction. Most of these reactions are minor and can be treated, but sometimes they can be more serious
  • Transfusion-related lung injury is one of the more serious risks. It can cause trouble breathing and require treatment in the hospital.
  • Getting exposed to certain germs such as HIV, hepatitis B, or hepatitis C. But the careful screening that’s used today has greatly decreased the risk of infections.

Talk to your doctor about whether you have a risk for a low platelet count, and what options might be best for your situation.

What a patient with a low platelet count can do

  • Use only an electric razor (not blade) for shaving.
  • Avoid contact sports (such as wrestling, boxing, or football) and any other activities that might lead to injury or cause a fall.
  • Protect your skin from cuts, scrapes, and sharp objects.
  • Use a soft toothbrush.
  • If your mouth is bleeding, rinse it a few times with ice water.
  • Talk to your cancer care team about whether you should put off flossing your teeth until your platelet counts improve.
  • Do not blow your nose or cough with great force.
  • Keep your head level with or above your heart (lie flat or stay upright).
  • Use a stool softener to avoid constipation and straining during a bowel movement. Do not use enemas or suppositories of any kind. Check with your cancer care team before using laxatives.
  • Do not put anything in your rectum, including suppositories, enemas, thermometers, etc.
  • Stay away from anti-inflammatory pain medicines, such as aspirin, naproxen, or ibuprofen (Motrin®, Advil®, Naprosyn®, Aleve®, Midol®) and medicines like them unless your cancer team tells you to use them. Check with your pharmacist if you’re not sure whether a medicine is in this class of drugs, or if it contains one of them.
  • If bleeding starts, stay calm. Sit or lie down and get help.
  • Call your cancer care team or get immediate medical help if you have unusual bleeding or if bleeding of any kind does not stop.

What caregivers can do

  • Keep the home environment safe to help prevent injury and falls.
  • For nosebleeds, have the patient sit up with head tilted forward, to keep blood from dripping down the back of the throat. Put ice on the nose and pinch the nostrils shut for 5 minutes before releasing them. Ice on the back of the neck may also help.
  • For bleeding from other areas, press on the bleeding area with a clean, dry washcloth or paper towel until bleeding stops.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Balducci L, Shah B, Zuckerman K. Neutropenia and thrombocytopenia. In DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2019:2075-2076

Cancer.Net. 2018. Low platelet count or thrombocytopenia. Accessed at https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/managing-physical-side-effects/low-platelet-count-or-thrombocytopenia on September 17, 2019.

Choe JH, Crawford J. Hematologic problems and infections: Disorders of blood cell production in clinical oncology. In Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:521-522

Izak M, Bussel JB. Management of thrombocytopenia. F1000Prime Reports. 2014; 6(45): P6-45

Schiffer CA, Bohlke K, Delaney M, Hume H, Magdalinski AJ, McCullough JJ, Omel JL, Rainey JM, Rebulla P, Rowley SD, Troner MB, Anderson KC. Platelet transfusion for patients with cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. Journal of Clinical Oncology.  2018; 36(3):283-299

References

Balducci L, Shah B, Zuckerman K. Neutropenia and thrombocytopenia. In DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2019:2075-2076

Cancer.Net. 2018. Low platelet count or thrombocytopenia. Accessed at https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/managing-physical-side-effects/low-platelet-count-or-thrombocytopenia on September 17, 2019.

Choe JH, Crawford J. Hematologic problems and infections: Disorders of blood cell production in clinical oncology. In Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:521-522

Izak M, Bussel JB. Management of thrombocytopenia. F1000Prime Reports. 2014; 6(45): P6-45

Schiffer CA, Bohlke K, Delaney M, Hume H, Magdalinski AJ, McCullough JJ, Omel JL, Rainey JM, Rebulla P, Rowley SD, Troner MB, Anderson KC. Platelet transfusion for patients with cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. Journal of Clinical Oncology.  2018; 36(3):283-299

Last Revised: February 1, 2020

American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.