Platelets are the smallest cellular component in the blood, but they play a very important function to stop you from bleeding. The platelet’s role is to initially recognize that you are bleeding and to go to the blood vessel where you are injured. Once they show up, they are activated and ignite the process of clotting bringing even more platelets and the protein factors that make a firm clot. They, themselves, become a part of the clot and they serve as a surface on which the proteins can attach and become activated to reinforce and strengthen the clot.
Platelet disorders can result from either not having enough platelets or having platelets that don’t work the right way. The symptoms of having a platelet disorder can be similar to other bleeding disorders and might include frequent severe nosebleeds, bleeding from the gums, easy bruising, trouble with bleeding after an injury or surgery, bleeding in the stools, or heavy menstrual bleeding in girls. The severity of any or all of these symptoms may vary. Bleeding and bruising are symptoms that happen commonly to all of us and it may be difficult to tell if it is excessive or abnormal. Some of these disorders may be passed on from parents to their children, and so it may be harder for parents who are affected to tell if the symptoms are abnormal. Detecting a platelet dysfunction can be tricky, but usually includes taking a careful history, including family history, as well as specific laboratory tests that can tell how many platelets a person has and how well they work.
Not having enough platelets can cause a slow response to injury and prolongs the start of the clotting process. It also may take longer for the clot to fully form and once it is formed, the clot may be weaker and more prone to breaking apart, which may cause re-bleeding several hours later. Some of the more common disorders that cause low platelet numbers include ITP, NAIT, TAR, CAMT, and MYH9 family of disorders.
Some patients may have enough platelets but if they do not work properly, it may still be difficult to form a blood clot. The dysfunction may affect just one of the roles that platelets play in the formation of a clot, or it may affect all of them. One of the most common reasons for a functional problem would be due to certain drugs such as aspirin, NSAIDs like ibuprofen, or clopidogrel. Inherited disorders are less common but would include conditions like Glanzman’s thrombasthenia, Bernard-Soulier Syndrome, Gray platelet syndrome, Hermansky-Pudlak syndrome, and Wiskott Aldrich Syndrome.
Effective treatments for all bleeding disorders are available. Donated platelets may be given to replace those in a patient’s body when emergencies arise. Many of these patients may also manage their bleeding using a combination of therapies which might include desmopressin, an antifibrinolytic agent such aminocaproic acid or tranexamic acid, local first aid treatment, and hormonal regulation. Care for a patient with a platelet disorder is best delivered with the help of a center that has expertise treating and managing these patients such as can be found at a federally recognized Hemophilia Treatment Center.