Thrombocytopenia occurs when there aren’t enough platelets, which are tiny blood cells that help with clotting. In some cases, thrombocytopenia is the first sign of acute HIV infection.

Severe thrombocytopenia can lead to bleeding both inside and outside of the body as the blood struggles to or cannot clot.

It used to be a more common complication for people with HIV. Although it can still happen at any stage of HIV, modern antiretroviral therapies have led to fewer cases of thrombocytopenia.

A 2021 review found that thrombocytopenia affects 4–40% of people with HIV across the globe. Prompt treatment with highly active antiretroviral therapy (HAART) may lower the rates of thrombocytopenia.

Progression of HIV may be marked by the onset of thrombocytopenia, but it can occur at any time in the course of HIV infection.

It’s not always clear what causes thrombocytopenia in people with HIV.

It’s possible that HIV’s damage to the immune system leads to the condition as the immune system may start destroying platelets.

For some people, medication to treat HIV (particularly drugs like zidovudine and ritonavir) may result in thrombocytopenia.

This condition might occur because these drugs could slow down platelet production or cause the body to destroy platelets.

Having a higher HIV viral load and lower CD4+ T cell count can raise the chance of this particular complication.

Coinfection with the hepatitis C virus can also increase your risk.

Mild cases of thrombocytopenia often have no symptoms.

When symptoms do arise, they may involve:

  • bruising easily, which may be purple, red, or brown in color
  • unmanageable bleeding or bleeding that lasts longer than usual when injured
  • flat, red, or purple spots under or on the skin
  • blood in urine or stool
  • nosebleeds
  • bleeding from the gums
  • heavier menstrual bleeding

These symptoms tend to be the same for people with and without HIV and can appear suddenly or over time.

As mild cases may have zero symptoms, thrombocytopenia is often found during a routine blood test.

If symptoms are present, similar blood tests will detect whether a person has thrombocytopenia.

A complete blood count (CBC) test can measure platelet levels in the blood to see if you have fewer platelets than expected. The average platelet count ranges from 150,000–450,000 per microliter of blood.

Sometimes, labs will examine blood and the appearance of the platelets under a microscope through a blood smear test.

Other potential tests include ones that look for antibodies that may destroy platelets. There are also tests that see how long the blood takes to clot.

Doctors will typically perform a physical examination, too, to see if they can spot any bruising or bleeding on the body.

They’ll also feel your stomach to see if your spleen feels bigger than it should. If your spleen is enlarged, it can lead to platelets being stored inside, causing thrombocytopenia.

Mild cases may not need treatment. But if thrombocytopenia is causing significant bleeding or other severe symptoms, your doctor will discuss your options for treatment.

For people with HIV, antiretroviral therapy can help boost platelet production. If that doesn’t work, you may be prescribed steroids or given a platelet transfusion.

In some cases, a splenectomy — where the spleen, which stores platelets, is removed — may be a better option.

For anyone — whether they have HIV or not — thrombocytopenia can lead to severe bleeding if left unmonitored and untreated. This can be life threatening.

People who are at more advanced stages of HIV and who also have thrombocytopenia may not be able to take certain medications that are typically used to treat HIV. So, treatment options may be more limited.

The condition can also speed up the progression of HIV to AIDS, according to research from 2021.

Thrombocytopenia can be curable, depending on what’s causing it. If it’s related to HIV, curing it may be tricky. But treatments are available to lower the severity.

It’s important to consult with a doctor if you feel you may have thrombocytopenia alongside HIV. Early diagnosis and treatment can help avoid more serious symptoms and complications.

Lauren Sharkey is a U.K.-based journalist and author specializing in women’s issues. When she isn’t trying to discover a way to banish migraines, she can be found uncovering the answers to your lurking health questions. She has also written a book profiling young female activists across the globe and is currently building a community of such resisters. Catch her on Twitter.