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Bleeding and Bruising - Thrombocytopenia

What is thrombocytopenia?

Certain serious childhood illnesses and treatments can cause:

  • Bleeding problems
  • Bruising
  • Tiny purple or red spots on the skin (called petechiae)

These can occur because there are fewer platelets in the blood. Platelets help form blood clots to slow or stop bleeding. A lower level of platelets in the blood is called thrombocytopenia. A healthy platelet count is between 150,000 and 300,000.

Graphic of petechiae, which are small red or purple pinpoint dots on the skin that can look like a rash.

Petechiae are flat, rash-like dots on the skin due to bleeding.

Impact of low platelet counts

Tell the care team right away if your child has bleeding problems, unusual bruising, tiny purple-red spots, or any of the below:

  • Bleeding that does not stop after a few minutes
  • Bleeding from the mouth, nose, or when throwing up
  • Bleeding from the vagina when not having their menstrual period
  • Bleeding during a menstrual period that is heavier or lasts longer than normal
  • Urine that is red or pink
  • Stools that are black or bloody
  • Bad headaches
  • Vision changes
  • Feelings of confusion or sleepiness

Diagnosing bleeding and bruising problems

To diagnose your child, your care provider must first decide the cause of the bleeding. Tests they do may include:

  • Physical exam and medical history – The care provider will look for signs of bleeding. They feel the abdomen to see if the spleen is larger than usual.
  • Complete blood count (CBC) test
  • Blood clotting tests – These tests are sometimes called a coagulation panel. They check for proteins in the blood that affect the clotting process.

Doctors may also perform a bone marrow aspiration to find the cause of the bleeding.

Learn more about blood by visiting the Basics of Blood website.

Treatment of thrombocytopenia

Serious cases of thrombocytopenia may require:

  • Treating the underlying condition. For example, if the low platelet count is caused by a medicine side effect, stopping the medicine might resolve the problem.
  • Transfusions. A transfusion replaces lost platelets with new ones. Donor platelets are given to by vein either through a central venous access device or an IV.

Prevent bleeding and bruising in children with serious illnesses

You can take steps to prevent bleeding and bruising if your child has a serious illness.

  • Avoid certain medicines and herbal products. Many over-the-counter medicines have aspirin or ibuprofen. This can increase the risk of bleeding. Some herbs can also affect bleeding. Your care team will provide a list of medicines and herbal products to avoid. If not, ask for one.
  • Brush teeth gently with a very soft toothbrush.
  • Wear shoes, even when inside.
  • Be extra careful when using sharp objects. If your child is older, they should use an electric shaver to shave.
  • Use lotion and lip balm to prevent dry skin and chapped lips.
  • Avoid physical activities that may result in bruising or injury.
  • Do not take body temperature rectally.
  • Do not pick at scabs or pimples.
  • Menstruating girls should use sanitary pads instead of tampons.

Home care tips

Daily activities can cause bleeding or bruising. Use the following tips to care for your child at home.

  • Gum bleeding. Rinse mouth with ice or cold water.
  • Nose bleeding. While your child is sitting up straight, apply pressure to the outsides of each nostril, just below the bridge of the nose. Pinch the area with the thumb and finger and hold gentle pressure for 5-10 minutes.
  • Other bleeding. Apply gentle pressure with a clean cloth to the area until the bleeding stops.
  • Bruising. Put ice on the area for about 20 minutes.

If bleeding does not stop after 5 to 10 minutes, contact a member of your care team.

Key Points

  • Children with serious illnesses and those going through certain types of medical treatments can have a higher risk of bleeding and bruising.
  • Symptoms include bleeding too much, bruising, or tiny purple or red spots on the skin.
  • Call your child’s care team if you notice bleeding and bruising.
  • Follow your care team’s directions about treatment and prevention exactly.

Reviewed: September 2022