Alcohol-Induced Thrombocytopenia: A Reversible but Dangerous Condition

Abstract

Introduction: Thrombocytopenia is a common hematological condition that can occur in various clinical scenarios, ranging from infectious diseases to toxic exposures. One of the less commonly recognized but important causes of thrombocytopenia is acute alcohol consumption. Studies show that acute alcohol intake can reduce platelet counts by 30–75% within 12–24 hours. Case description: A 39-year-old man presented to the emergency department with complaints of severe general weakness, palpitations, and cold sweats. The symptoms began around 3 AM. The patient denied any signs of bleeding. He had no known comorbidities, allergies, or regular medications. His medical history included long-term smoking and physically demanding work. A complete blood count revealed severe thrombocytopenia for the first time – platelet count (PLT) was 17 x10⁹/L, while other parameters were within normal limits (RBC – 4.56 x10¹²/L, WBC – 4.9 x10⁹/L). ECG showed sinus rhythm with a heart rate of 58 bpm. Blood pressure was 140/90 mmHg. Physical examination revealed no significant abnormalities – the liver and spleen were not enlarged. A repeat blood test performed 8 hours later showed an increase in platelet count to 44 x10⁹/L. Treatment consisted only of blood pressure control with one tablet of diltiazem. Given the positive trend in PLT levels, platelet transfusion was withheld. Upon further questioning, the patient admitted to having consumed a large amount of alcohol – about 2–3 liters of vodka – two days prior. A follow-up CBC performed 24 hours later showed a further increase in PLT count to 124 x10⁹/L. As the patient's symptoms had resolved and platelet levels continued to rise, he was discharged home with a recommendation to repeat the CBC in one week and monitor his platelet count. Conclusions: Acute high-dose alcohol consumption can suppress bone marrow function, leading to reduced platelet production. In addition, alcohol directly affects platelet membranes, increasing their destruction in the spleen and reducing thrombopoietin production in the liver, further contributing to thrombocytopenia. In this case, the patient’s thrombocytopenia resolved spontaneously after cessation of alcohol intake, confirming a toxic etiology. Early recognition and differentiation from other causes of thrombocytopenia are essential.