Anemia and thrombocytopenia cause low levels of red blood cells and platelets. This can cause fatigue and bleeding problems.

Thrombocytopenia is a low platelet count. Platelets, also known as thrombocytes, are small blood cells that bone marrow produces. Platelets help the blood clot in order to heal wounds. Low platelet counts can cause bleeding problems.

Anemia is a lack of healthy red blood cells. Red blood cells carry oxygen around the body, so anemia may cause people to experience fatigue or shortness of breath.

This article will describe anemia and thrombocytopenia in more detail and explore a range of medical conditions that may cause them to occur together.

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People with mild cases of thrombocytopenia may not notice any symptoms, and doctors often discover it through a routine blood test.

If thrombocytopenia does cause symptoms, people may notice signs of abnormal bleeding, such as:

  • bleeding that lasts a long time after small cuts or injuries
  • petechiae, which is bleeding from blood vessels that appears as pinprick-like discolored spots under the skin
  • purpura, which is bleeding in the skin, causing red, purple, or brown-yellow spots
  • bleeding from the gums or nose
  • blood in the urine or stool
  • heavy menstrual bleeding

These symptoms may appear suddenly or gradually over time.

Symptoms of anemia may include:

People with mild anemia may not experience symptoms.

According to a 2021 case report, various medical conditions can cause anemia and thrombocytopenia. These include:

Thrombotic microangiopathy

Thrombotic microangiopathy (TMA) is a syndrome in which people experience low platelet counts, hemolytic anemia, and organ damage.

Hemolytic anemia occurs when the breakdown of red blood cells happens faster than the body can create them.

Organ damage in TMA occurs through tiny blood clots forming in blood vessels. This commonly affects the kidneys but may affect any organ.

Learn more about hemolytic anemia.

Bone marrow disorders

Bone marrow disorders such as leukemia may cause anemia and thrombocytopenia. Leukemia causes damage to bone marrow and destroys stem cells, which are essential for healthy blood cells.

Learn more about leukemia.

Aplastic anemia

Aplastic anemia is a rare but serious blood disorder. It occurs if the bone marrow cannot make enough new blood cells.

Learn more about aplastic anemia.

Evans syndrome

Evans syndrome is a rare autoimmune condition in which the immune system attacks red blood cells and platelets.

Learn more about Evans syndrome.

Paroxysmal nocturnal hemoglobinuria

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare disorder in which the immune system destroys red blood cells.

People with PNH have impaired bone marrow function, which may also cause low levels of blood cells and platelets.

Other causes

Other causes of thrombocytopenia include:

  • Gene mutations: Certain genetic mutations people inherit may cause thrombocytopenia.
  • Immune system disorders: Autoimmune conditions, such as lupus or rheumatoid arthritis, may cause the immune system to mistakenly attack platelets.
  • Medications: Some medications, such as heparin, may slow down platelet production in the body or destroy platelets as a side effect.
  • Alcohol: Excessive alcohol consumption may cause a temporary drop in platelets.
  • Exposure to toxins: Certain toxins, such as arsenic, benzene, and pesticides, may slow platelet creation.
  • Blood clot disorders: Health conditions that cause blood clots may result in the body using up more platelets than usual, potentially leading to a low platelet count.
  • Infections: Bacterial and viral infections may lower platelet counts.
  • Abnormal spleen: Having a bigger spleen than usual may lead to a low platelet count, as the spleen stores and removes platelets.
  • Pregnancy: People may develop mild thrombocytopenia in the final stage of pregnancy, although the reason for this is unclear.
  • Surgery: Surgical procedures involving equipment such as artificial heart valves or tubes for blood transfusions may destroy platelets as blood passes through them.

Other causes of anemia include:

To diagnose anemia and thrombocytopenia, doctors may take a full medical history, assess symptoms, and carry out a physical exam to look for certain signs, such as bleeding or bruising.


To diagnose thrombocytopenia, a doctor may carry out tests such as the following:

  • Complete blood count: A blood test that measures levels of red blood cells, white blood cells, and platelets.
  • Blood smear: Healthcare professionals examine a sample of blood under a microscope to describe cell size, shape, maturation, and destruction.
  • Bone marrow tests: These involve examination of material that healthcare professionals take from inside the bone to see the production of blood cells.

In adults, a typical platelet level is 150,000 – 450,000 platelets per microliter (mcL) of blood. Platelet levels lower than this are atypical.


A doctor will also use results from a complete blood count to diagnose anemia. Results that may indicate anemia include:

  • abnormal levels of red blood cells and hemoglobin, which helps transport oxygen around the body
  • low levels of hematocrit, which measures how much space red blood cells occupy in the blood
  • atypical mean corpuscular volume, which measures the average size of red blood cells

Learn more about typical platelet counts.

Treatment of anemia and thrombocytopenia will depend on the underlying cause. People with mild anemia and thrombocytopenia may not require treatment.

However, people with severe bleeding or risk of complications will require treatment. Depending on the cause, this may include:

  • a change in medication when medication is causing a low platelet count
  • immunosuppressant drugs when the immune system is attacking platelets and blood cells
  • taking certain medications, such as corticosteroids or thrombopoietin receptor agonists, to increase platelet levels
  • receiving blood or platelet transfusions to treat severe cases
  • having surgery to remove the spleen, which stores platelets, to increase platelet levels in the blood

Treatments for anemia will depend on the severity and cause but may include:

Severe thrombocytopenia may be life threatening as it can cause heavy bleeding, internal bleeding, or bleeding in the brain. Prompt treatment is important to prevent complications.

Without treatment, anemia may increase the risk of:

The outlook for people with anemia and thrombocytopenia may depend on the underlying cause.

People with mild thrombocytopenia may not require treatment, as people do not require a full platelet count for the body to safely prevent excessive bleeding, including from serious injuries.

However, prompt treatment of severe thrombocytopenia is essential to prevent complications.

For mild anemia, treatment with supplements may resolve the condition. In more severe cases, blood transfusions can rapidly increase red blood cell levels.

If a chronic health condition causes anemia and thrombocytopenia, people may require long-term treatment to manage the condition.

Anemia and thrombocytopenia cause low levels of red blood cells and platelets. Various health conditions may cause both conditions.

If people experience symptoms of anemia and thrombocytopenia, they can contact a doctor. Severe anemia and thrombocytopenia may require prompt treatment to prevent serious complications.