Platelets help you clot your blood. If you have a low platelet count, you are at risk for bleeding. The question is how low is too low?
What is a normal platelet count?
Normal platelet counts are 150,000 and above. When below this, they grade it:
- MILD 101,000-150,000
- MODERATE TO SEVERE 50-100,000
- THROMBOCYTOSIS <50,000
Most things you read will say that as long as your platelet count is above 50K, you are fine. If you are symptomatic (do your gums bleed easily? do you bruise easily? if you cut yourself does it take a long time to stop the bleeding?) then this article is not for you. This is for those patients who feel totally fine and then in pre surgery bloodwork find out their platelet count is low.
Why would it be low?
- Your platelet supply is renewed every 10 days. They are made by cells in your bone marrow.
- It can be low because of genetics, medications, or medical conditions.
- Are the platelets trapped? this happens most often in the spleen.
- Are you making fewer platelets? This has to do with a bone marrow issue like leukemia, anemia, viral infections
- Are you breaking down the platelets too fast? This can happen because of pregnancy, immune issues, bacteria in the blood, medications, or TTP.
If your count is below 10,000, you can have dangerous internal bleeding.
So what does the literature say about it for elective surgery?
All surgeries are not created equal, so I decided to do a little research to see what studies are out there. There isn’t much talking about elective surgeries, but I found two studies.
I found a study in the Anesthesia literature:
- Perioperative Medicine | January 2014
- Preoperative Thrombocytopenia and Postoperative Outcomes after Noncardiac Surgery
- Interesting points:
- They did a retrospective study on 316,644 patients with noncardiac surgery who did not have clinical indications for preop testing of bleeding. This was done using data from the American College of Surgeons.
- Of these 1 in 14 were found to have low platelet counts and they had NO symptoms.
- When they looked at major complications:
- MILD low platelet count patients were more likely to be transfused 3% vs 7%
- MODERATE low platelte count transfusion risk was higher 3% vs 11.8%
- and had higher mortality rates 0.5% vs 1.5%
I found another more recent article of almost 4 million patients:
They found most complication differences were not significant when matched for the same type of surgery as those with normal platelet counts. The only difference they found correlated with the prior study of increased risk of perioperative transfusion and mortality.
- PLoS One. 2019 Feb 11;14(2):e0212191. doi: 10.1371/journal.pone.0212191. eCollection 2019.
Platelet count abnormalities and peri-operative outcomes in adults undergoing elective, non-cardiac surgery.
While pre-operative laboratory evaluation of the platelet count in patients who undergo elective, non-cardiac surgery is common, abnormalities in platelet counts are not. When patients with apparent thrombocytopenia are matched carefully with normal-platelet-count patients based on a variety of peri-operative factors and are matched exactly by principal procedure and primary diagnosis underlying their surgeries, most of the differences in terms of complications–including minor or major complications, discharge to any place other than one’s home, unplanned or unscheduled operation or re-admission within 30 days–are no longer significant. However, the odds of perioperative transfusion and 30-day mortality remain increased, particularly for patients with moderate, severe, and critical thrombocytopenia. These findings may guide surgeons and others to better appreciate the utility of pre-operative screening of the platelet count prior to an elective, non-cardiac surgery.
My thoughts?
If you do not have symptoms and your count is above 100,000, you are likely fine. Your biggest risk is bleeding, but needing a transfusion for elective surgery is a low risk in my experience. You are at a higher risk for bleeding, objectively shown by the two large studies cited. Why is your platelet count low? If it is genetics, that is not something you can change. If it is another issue, there may be remedies you can do before scheduling your surgery. Discuss it with your plastic surgeon.
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