Another name for platelets is thrombocytes. These are the cells in the blood that assist in clotting. They are manufactured in the bone marrow. The condition where the platelet count is low is also called thrombocytopenia. Children with this condition bruise or bleed easily during injury regardless of how minor the injury is. They are also at a high risk of bleeding from the nose, mouth and gastrointestinal tract compared to other children.

Symptoms of Low Platelet Count in Children

The normal count of platelets in a child is around 160 to 500 x 10⁹/L. The thrombocytopenia condition arises when the platelet count is below 100 x 10⁹/L. The lower the platelet numbers, the higher the risk of hemorrhage and bleeding.

Level of Thrombocytopenia	Platelet Count (x 109/L)
Mild	75.0-99.9
Moderate	50.0-74.9
Moderately severe	20.0-49.9
Severe	Less than 20.0

Symptoms:

A child with thrombocytopenia will show the following symptoms:

• Bleeding from the gums
• Constant nose bleeding
• Unexpected bruising
• Petechiae or small red spots which are under the skin
• Urine that is brown, red or pink in color
• The bowel movements that are black or bloody
• The child will vomit a substance that seems like ground coffee or is bloody
• The vision will change or the child will experience headaches
• After a scrape or cut he/she will bleed for too long

Causes of Low Platelet Count in Children

There are several reasons why a child has a low platelet count. It could be caused by infections like rubella, viral or even bacterial infections. It can also arise when the mothers' immune system generates antibodies against the platelets of the baby. Some medicines taken by the mother or the baby could also result in thrombocytopenia. Generally, the causes could include:

1. Decreased Platelet Production

Production of platelets can be reduced if your bone marrow is affected things like:

• Viruses like Epstein-Barr and mumps
• Cancers like leukemia
• Medication in chemotherapy
• Radiation therapy to the pelvis or if it affects the major part of the bone marrow

2. Increased Platelet Destruction

There’s a condition known as idiopathic thrombocytopenic purpura (ITP) whereby the body targets the platelets and mistakes them as foreign cells and produces antibodies against them.

Another condition that causes thrombocytopenia is HUS or hemolytic-uremic syndrome, which occurs from a particular strain of E.coli that causes food poisoning and diarrhea in children.

3. Increased Sequestration

The immune system of the body includes certain organs such as the spleen. This organ under specific conditions may rapture and expel platelets in excess and their circulation numbers will be less. This can take place if the spleen is enlarged by certain conditions and one of them is liver cirrhosis, which could be as a result of the hepatitis infection.

Diagnosis & Treatments of Low Platelet Count in Children

Diagnosing low platelet count or thrombocytopenia is normally done by checking platelet levels using a complete blood count (CBC) and a physical examination as well. The treatment of low blood platelets depends on what has caused it, overall health, the child’s age (gestational) and the extent of the medical history of the disease. The child’s tolerance for specific procedures, therapies or medication is also put into account.

When it comes to chemotherapy, children with thrombocytopenia either get a smaller dose or wait for long between the cycles in chemotherapy. If the platelet count is below 20 and the child experience bruising a lot or bleeding, then they may require a platelet transfusion.

Note: the child shouldn’t be given any medication without consulting the doctor.

Prevention of Bleeding

There are tips in place alongside medical treatment that can aid the child with a low platelet count and prevent them from bleeding.

• Use a soft toothbrush;
• Prevent them from lifting objects that are heavy and keep off strenuous sports;
• Eat foods that are soft like mashed potatoes, soup and pudding and avoid sharp, spicy, acidic or crunchy foods;
• The nose should be blown softly not forcefully;
• Don't give the child medication that contains aspirin for it lowers the bloods ability to clot;
• Apply lotion to the skin to keep it moist;
• If the child’s platelets are low, then he/she shouldn’t be given intramuscular (IM) injections.

What to Do If Bleeding Happens

Areas of Bleeding	What to Do and What Not to Do
Nosebleeds	The child should be upright siting down and the head tilted forward. Press a cold cloth on the sides of the nose and hold for 10 minutes. You can also put a cold cloth on the back of the neck. If the bleeding continues for long seek medical advice.
Bleeds from a Cut	Put pressure on the cut using a dry, clean cloth. If bleeding doesn’t stop, then call paramedics. Don’t apply any tourniquet to stop the bleeding for it may cause damage to the tissues permanently.
Bleeds Under Skin	Put pressure on the affected area using a soft cloth or an ice pack for about 10 minutes. If possible, the area should be kept above the heart level.
Bleeds from Gums or Mouth	If the area where bleeding is taking place is reachable, apply pressure gently until it ceases. If it’s difficult to reach then let the child hold in their mouth ice water or have them suck a Popsicle until it stops bleeding.
Bleeds from Rectum	Never take the child’s temperature by the rectum. Never give them medicine through the rectum like suppositories, enemas or rectal exams. Encourage taking of fluids and plenty of fiber to prevent constipation, bleeding and strains from the rectum.

When to See a Doctor

Low platelet count in children and adults may have symptoms similar to other medical problems or conditions. Nevertheless you should call a doctor if:

• There’s unusual bleeding for more than 10 minutes;
• Vomiting of material that is either bloody or coffee ground like;
• There’s presence of blood in the urine or stool;
• There are small purple or red spots present under the skin;
• There’s more bruising on places like the chest, head, abdomen, waist or head than the knees and elbows;
• Headaches occur suddenly and severely;
• The child is extremely sleepy or unable to wake up.