A stylized figure has a nosebleed.

Signs of Low Platelets, aka Thrombocytopenia

Who even talks about platelets? People with hep C do, that’s who. When you are wondering about the signs of low platelets, or thrombocytopenia, this will help. Low platelets are pretty mysterious. It all involves the liver, spleen, and inflammation. By the way, I call it platelet-hoarding instead of that big word that starts with a T.

What is thrombocytopenia?

Basically, it means low platelets. Platelets are the blood cells that help in clotting. Without them, your blood won’t clump well during any type of injury and you’ll bleed easily.

Signs of low platelets

The signs of low platelets, aka thrombocytopenia, include:

  • Enlarged spleen
  • Easily bruising
  • Fatigue
  • Jaundice
  • Red rashy spots (petechiae)
  • Bleeding a lot (cuts, periods, teeth brushing, nose, stool, vomiting)

Normal platelets versus too many

The normal amount of platelets circulating in your whole body is ~150 to 450 per microliter of blood. Remember, though, the spleen will hold onto about 1/3 of your platelets. You may have read about the spleen already, but it can become swollen if you are fighting the hepatitis C Virus.

What I call "hoarding": Sometimes, there are just too many platelets sticking around in your spleen. When your spleen is swollen, it will hoard too many. It is trying to help use up any old blood cells, and instead, gets stuck in a cycle. That’s because when you have cirrhosis or liver distress, your spleen goes overboard trying to fight the infection, and filter your blood. Your spleen gets more and more swollen. It all creates a huge imbalance in your body.

Platelets are produced in your bone marrow.  With the hep C virus, or with other diseases, your body does not make enough. That means there are fewer platelets in your bloodstream. It can be risky because without platelets, as your blood won’t clot as easily.

Treatment options

Here are some treatment options that your doctor may recommend:

Addressing the cause

First, get rid of the cause of liver disease, which for me was hepatitis C. You may be offered Promacta to help until your body is stronger. Because of liver failure, my platelets never got above 60 anyway. When I used the old treatment, they dropped to 30 at one point. Luckily, I was able to get in touch with a pharmaceutical company and got a very low copay.


Medication can make it easier for someone who is trying to deal with signs of low platelets. As a last resort, getting packed red blood cells, or platelets, can be used. I did that more than once.


When platelets are low, be sure and practice safety when exercising, walking, or riding your bicycle. Try to keep yourself strong so you don’t lose your balance and fall. The risk of internal bleeding is real. If you have bleeding varices, take your meds, and you may prevent bleed outs from low platelets.

If your blood labs show signs of low platelets, follow your doctor’s orders. In time, after finishing treatment and getting rid of the virus, I was able to keep my platelets up! Many people report their spleen going back to normal size after successfully treating for Hep C. The spleen can quit hoarding platelets too. Getting rid of the virus gave me a boost in that area for sure!

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