Thrombocytopenia occurs when your blood platelet levels are too low. Doctors use a grading system to determine the severity of your thrombocytopenia and its treatment.
Thrombocytopenia is when the levels of platelets (also called thrombocytes) in your blood are too low. Platelets are tiny blood cells that help your blood to clot.
When you have thrombocytopenia, you can have trouble stopping bleeding when it occurs. You may also experience bleeding under your skin. If platelet levels get very low, it can lead to potentially serious or life threatening internal bleeding.
In some situations, doctors may grade thrombocytopenia to assess its severity or the bleeding associated with it.
This article takes a closer look at the grading criteria for both chemotherapy-induced thrombocytopenia and immune thrombocytopenia.
What are the primary types of thrombocytopenia?
Immune thrombocytopenia (ITP):
Chemotherapy-induced thrombocytopenia (CIT):
Immune thrombocytopenia (ITP) is a condition in which your immune system mistakenly attacks platelets. This leads to a reduced platelet count.
The development of ITP is associated with certain drugs, infections, and some preexisting autoimmune conditions. ITP can impact people of all ages. An estimated 40% of those diagnosed with ITP are children under the age of 10.
Grades and treatment of immune thrombocytopenia
While platelet count is an important part of the diagnosis of ITP, grading often involves evaluating the severity of the bleeding. There are several grading systems for bleeding that may be used.
One of these is the Buchanan and Adix bleeding score. The table below shows the different grades of this system.
| Grade | Findings |
|---|---|
| Grade 0 | no bleeding observed |
| Grade 1 | minor skin bleeding, such as five or fewer small bruises and/or 100 or fewer petechiae |
| Grade 2 | more significant skin bleeding, such as more than five large bruises and/or over 100 petechiae |
| Grade 3 | signs of mucosal bleeding, such as blood crusting in nostrils or nosebleed, petechiae or purpura in the mouth, blood in the urine or stool, and heavy periods |
| Grade 4 | more severe mucosal bleeding or suspected internal bleeding, such as in the brain or lungs that requires immediate medical attention |
| Grade 5 | confirmed brain bleed or other life threatening or fatal bleeding |
Higher grades are associated with more severe disease. A
The treatment of ITP depends on many factors, including but not limited to the grade of the bleeding, how low platelet levels are, and the age of the person with ITP. Some potential treatment options can include one or a combination of:
- corticosteroids
- intravenous immunoglobulin (IVIG)
- drugs that help to raise platelet count
- platelet transfusions
- removal of the spleen
Chemotherapy is a cancer treatment that uses drugs that interfere with the growth and division of cancer cells. Chemo drugs can also affect areas of the body where healthy cells are growing and dividing, such as the bone marrow.
Platelets are made in the bone marrow. Because of this, the effects of chemo can reduce the number of platelets that are made. This is called chemotherapy-induced thrombocytopenia (CIT).
A
Grades and treatment of chemotherapy-induced thrombocytopenia
CIT is graded based on how low your platelet levels are. Platelet levels can be measured using a blood test called a complete blood count. The table below shows the
| Grade | Platelets per liter (L) of blood |
|---|---|
| Grade 1 | 75×109 to less than 100×109 |
| Grade 2 | 50×109 to less than 75×109 |
| Grade 3 | 25×109 to less than 50×109 |
| Grade 4 | less than 25×109 |
Higher grades indicate more severe CIT. A
Higher grades (grades 3 and 4) are considered severe and need to be addressed. Severe CIT may be managed by:
- reducing the dose or frequency of the chemo
- switching to a different chemo regimen
- platelet transfusions
- drugs that promote platelet production
Thrombocytopenia happens when your platelet counts get too low. In some situations, such as CIT and ITP, a grading system may be used to assess the severity of the thrombocytopenia or the bleeding associated with it.
Generally speaking, lower-grade thrombocytopenia may not require immediate intervention. However, severe thrombocytopenia needs to be addressed promptly in order to help prevent potentially life threatening complications.