Q: My grandmother has a low platelet count. She has to travel to India in less than 2 weeks and I need urgent advice. I spoke to the doctor at the haematology clinic about her travelling to India and he said its risky. He prescribed tranexamic acid tablets, which should reduce the risk of bleeding, but if incase she bleeds, then is it possible to receive platelet transfusions in India. She will be travelling for three weeks.

A:Platelets may be low due to: a) Increased destruction (immunologic – infections, drugs; gestational thrombocytopenia) or utilization (disseminated intra-vascular coagulation; abnormal vasculature as seen in hemolytic uremic syndrome & thrombotic thrombocytopenic purpura) b) Decreased production (leukaemia, aplastic anaemia, megaloblastic anaemia, drugs, infections c) Sequestration in the spleen (cirrhosis of liver). Idiopathic thrombocytopenic purpura (ITP) is the presence of isolated thrombocytopenia with a normal bone marrow and the absence of other causes to account for it. There are two distinct types acute ITP in children and chronic ITP in adults. No treatment is required when the platelet counts are more than 50,000/ml. Treatment is indicated a) When platelets are less than this and there is significant mucous membrane bleeding; b) In patients with hypertension, peptic ulcer disease or vigorous lifestyle who have a risk factor for bleeding c) When platelet count is <20,000-30,000/ml. Glucocorticoids and intra-venous gammaglobulins (I.V. Ig) are the mainstays of medical therapy. Their use and dose is dictated by the symptoms, patients clinical condition and the platelet count. Platelet transfusion is indicated for controlling severe hemorrhage. Platelet survival is increased if the platelets are transfused immediately after I.V. Ig infusion. Most major hospitals in Delhi have a department of transfusion medicine and platelets are readily available (though the patients family must donate). I am not too sure about the facilities in Haridwar and you need to check that locally.