Thrombocytopenia in Childhood Cancer

Thrombocytopenia

Symptom Management, Palliative Care, or Supportive Care to relieve side-effects is an important part of cancer care and treatment and should always form part of the overall treatment plan.

Thrombocytopenia is a blood disease characterised by an abnormally small number of platelets, also called thrombocytes, in the blood. They stop bleeding by helping the blood to clot and plugging damaged blood vessels.

Thrombocytopenia occurs when the body does not make enough platelets, is losing platelets, or destroys platelets. Thrombocytopenia is common in individuals with cancer, especially in those receiving chemotherapy.

Many things can cause thrombocytopenia in children, most commonly infections (especially viral infections) and destruction of platelets by the immune system (called immune thrombocytopenia or ITP). Children with thrombocytopenia may also have lower numbers of other blood cell types, such as red and white blood cells, depending on the cause.

 

Symptoms

Symptoms often do not occur until the level of platelets is very low, which is why many individuals do not know they have thrombocytopenia until it is diagnosed during a blood test. If your child has Thrombocytopenia, they could present with the following symptoms:

  • Black or bloody bowel movements or red- or pink-coloured urine
  • Bleeding from the nose or gums
  • Bloody vomit
  • Dizziness
  • Heavier than usual menstrual periods
  • Increased weakness
  • Pain in the joints or muscles
  • Severe headaches
  • Small purple or red spots under the skin, called petechiae
  • Unexpected bruising

If your child shows any of the above symptoms of thrombocytopenia, speak to their doctor about it immediately.

 

Causes

Platelets and red and white blood cells are formed in bone marrow (the soft, spongy tissue found inside larger bones).

Some types of chemotherapy and some other medications damage the bone marrow, lowering its production of platelets. Thrombocytopenia caused by chemotherapy is usually temporary; in very cases, the chemotherapy may permanently damage some of the bone marrow cells that make platelets.

Sometimes an individual’s body can make specialised proteins called antibodies that cause their immune system to attack their platelets.

Antibodies normally help destroy anything that appears harmful to the body, such as bacteria and viruses, but sometimes the process goes a bit haywire and antibodies are produced that destroy healthy parts of a person’s body.

Radiation Therapy alone does not commonly cause thrombocytopenia, unless the patient is receiving chemotherapy at the same time, a significant amount of radiation is directed at the pelvis, or the cancer metastasises (spreads) to the bone.

Thrombocytopenia can also occur when cancer cells, such as leukaemia or lymphoma cells, crowd normal bone marrow cells. Although rare, thrombocytopenia can also occur when other cancers, such as prostate or breast cancer, spread to the bone marrow.

Cancer of the spleen is another unusual cause of thrombocytopenia. Excess platelets are stored in the spleen, and cancer of the spleen can cause it to become enlarged, trapping too many platelets.

 

Diagnosis

Thrombocytopenia is diagnosed with a blood test called a platelet count, which counts the number of platelets in a sample of blood.

Individuals with certain types of cancer or those who are undergoing a type of cancer treatment known to cause thrombocytopenia may be given regular blood tests to look for thrombocytopenia and other blood-related complications.

 

Management/Treatment

Relieving side effects is an important part of total cancer care and treatment, which is why you should discuss any symptoms your child is experiencing, new symptoms and changes in symptoms with their Oncology Team so that they can work out a regimen of palliative or supportive care for them.

Individuals whose platelet counts drop while receiving chemotherapy may be switched to a lower dose or the doctor may wait longer between chemotherapy cycles. Some patients receiving chemotherapy may be given medication to help prevent severe thrombocytopenia.

Any cancer surgery your child may need to undergo may be delayed until their platelet counts are restored to a normal level due to the risk of bleeding.

If your child has a low platelet level, they may be given a transfusion of platelet cells to prevent spontaneous, heavy bleeding. Transfused platelets only last about three days though, so multiple transfusions may be required. Platelets received via a transfusion generally do not last as long in patients who have received many transfusions.

Apart from any treatment given to your child by their doctor, the following tips may help avoid problems if their platelet levels are low:

  • Do not give your child any medications without their doctor’s express permission because some medications can make bleeding problems worse;
  • Do not let your child play any contact sports or do any other activities that might cause them injury;
  • Give your child an extra soft toothbrush to use and don’t let them floss if their gums bleed;
  • Help them to blow their nose gently using a soft tissue;
  • Make sure that they are careful when using knives, scissors, needles, or any tools,