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DEAR DR. ROACH: I’m 80. Over the past 26 years, I’ve had low blood platelet counts. (In 1998, one reading was 168,000, and in 2026, the reading was 117,000.) I have an enlarged spleen (16.1 centimeters), and I understand that this could account for my low platelet count. I do have tiny red dots on my chest. However, my doctor thinks that I have leukemia and is preparing me for a spinal tap.
My doctor seems to be ignoring the spleen issue. My brother had a spleen removed (at age 5) because it was destroying his blood count. My mother did die from leukemia. My question is, would my spleen be the culprit behind my low platelet count (besides age)? -- R.H.
ANSWER: Low platelet counts are common, and one common reason for them is a condition called idiopathic thrombocytopenia (ITP). An enlarged spleen isn’t common with ITP, even though removing the spleen is one treatment.
The red dots on your chest might be petechiae -- small areas where red blood cells leak through small blood vessels. They can happen due to low platelets from any cause, but usually happen with much lower levels of platelets than you report; typically, petechiae are seen with platelet counts below 20,000 or even 10,000.
If the spleen enlargement is new, this would be a “red flag” that something in your bone marrow is new and different. Since people with ITP are at a substantially increased risk for leukemia (eight times the average risk), leukemia is definitely a concern, since spleen enlargement is universal with some types of leukemia and common with many others.
Because your doctor said that they think you have leukemia, I’m worried that there might be something very abnormal with your blood count. A lumbar puncture (“spinal tap”) is certainly done for most cases of acute leukemia, but the diagnosis of leukemia (acute or chronic) is made through an examination of your bone marrow, which should be done before a lumbar puncture.
It’s important to recognize that your spleen isn’t the cause of the low platelets (or leukemia). The spleen is where old platelets are normally removed by the body, which is why it may be removed in people with ITP. But since an enlarged spleen may also be a sign of leukemia, I’m concerned that your doctor might be right, and you should follow their advice.
DEAR DR. ROACH: In a recent column, you wrote: “It’s important to be sure that the urine is actually infected with -- rather than colonized by -- pseudomonas.” Please explain the difference. -- G.W.
ANSWER: The bladder can be colonized by bacteria, meaning that a lab test shows the presence of bacteria -- sometimes at very high amounts. But a person doesn’t experience any symptoms (such as burning, excess urination or tenderness) or signs (especially fevers).
Treatment is more likely to cause more harm than good in a person who has bacteria in their urine but doesn’t have symptoms (colonization). But treatment is appropriate when a person does have symptoms (infection).
Symptoms aren’t always easy to recognize, especially in patients with communication difficulties. Sometimes a patient’s caregivers can spot subtle differences in behavior that might indicate a true infection, not colonization.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2026 North America Syndicate Inc.
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