- From destruction of thrombocytes → serious bacterial infections, abuse of chemotherapy and antibiotics, systemic pathologies
- From excessive platelet consumption → vitamin B12 and B9 deficiency, recurrent infections, megaloblastic anemia, eczema, disseminated intravascular coagulation
- From sequestration of thrombocytes → liver cirrhosis
When the values of circulating platelets are low (between 50,000 and 150,000 units/mm3) but not too much, thrombocytopenia can be asymptomatic. When the values drop considerably, the patient may complain of bleeding, epitaxy, ecchymosis, gastrointestinal and urinary hemorrhages, menorrhagia, cerebral hemorrhages.
- Complications: platelet hemorrhagic syndrome
The information on Thrombocytopenia – Drugs for the Treatment of Thrombocytopenia is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and/or specialist before taking Thrombocytopenia – Drugs for the Treatment of Thrombocytopenia.
Mild thrombocytopenia – when the platelet count is slightly below the normal range (<150,000 units/mm3) – does not require special treatments or care, given that the condition tends to stabilize on its own, except, of course, for patients who complain of appreciable symptoms. The same goes for pregnancy thrombocytopenia: in many pregnant women (around 10%) a significant alteration in the platelet count is observed which, generally, does not cause damage to either the mother or the child, and tends to return to the normal range after the birth of his son.
When thrombocytopenia becomes significant, it is necessary to intervene with pharmacological therapy and/or a blood transfusion: the therapeutic approach – it is important to remember – should be undertaken only after having identified the triggering cause. To give an example, thrombocytopenia may depend on the administration of certain pharmacological specialties: in this case, the first measure to consider is the suspension of the drug and possibly its replacement with another.
In patients in whom thrombocytopenia causes severe bleeding, it is possible to intervene following several different approaches:
- Administration of glucocorticoid drugs orally or intravenously (to counteract bleeding)
- Administration of intravenous immunoglobulin (to treat thrombocytopenia dependent on an abnormal immune reaction)
- Platelet transfusion: Reserved for patients with obvious bleeding and high risk of bleeding
- Removal of the spleen: Reserved for extreme cases, in which drugs have brought no observable benefit
Below are the classes of drugs most used in therapy against thrombocytopenia, and some examples of pharmacological specialties; it is up to the doctor to choose the most suitable active ingredient and dosage for the patient, based on the severity of the disease, the patient’s state of health and his response to the treatment:
Corticosteroids: It is rather complicated to report a precise dosage of corticosteroid drugs for the treatment of thrombocytopenia, given the different response of patients to treatment and the variable intensity of the symptoms. The doses shown below are indicative: consult your doctor before taking the medicine.
- Prednisone (e.g. Deltacortene, Lodotra): indicatively, take the drug at a dose of 20-60 mg per day, for severe forms of thrombocytopenia. The drug can also be taken for the treatment of severe forms of thrombocytopenia during pregnancy: in this case, it is indicatively recommended to take an active dose equal to 1mg/kg of extrapregnant body weight. Treatment must be maintained at the minimum dose necessary to avoid bleeding complications, i.e. preventing platelets from falling below the value of 50,000 units/mm3.
- Dexamethasone (e.g. Decadron, Soldesam): dexamethasone, thanks to its anti-haemorrhagic effect, is indicated for blocking haemorrhages caused by thrombocytopenia. Indicatively, take the drug at a dose of 40 mg/day for 4 days. Continue with 28 days of suspension and repeat the cycle, respecting the instructions prescribed by the doctor.
- Cortisone (e.g. Cortis Acet, Cortone): for the treatment of idiopathic (immune) thrombocytopenia, it is recommended to take 25-300 mg of the drug per day, orally or intramuscularly, dividing the load into one or two doses.
- Triamcinolone (e.g. Kenacort, Triamvirgi, Aftab): indicated for idiopathic thrombocytopenia at a dose of 16-60 mg per day.
The duration of corticosteroid therapy varies from 5 to 6 months. If the amount of corticosteroids required by the body is high, splenectomy may be considered, to escape the side effects that long-term therapy with steroid drugs would cause.
- Miglucerase (e.g. Cerezyme): this is a drug indicated for enzymatic therapy, where thrombocytopenia is a characteristic symptom of important pathologies such as Gaucher syndrome. It is not possible to report an indicative dosage, given that the precise dosage must be personalized based on the patient. In any case, the drug is available in concentrated powder (solution for infusion): it seems that some patients respond positively by taking 2.5 units/kg, three times a week, up to a maximum of 60U/kg once every 2 weeks . The duration of the IV injection is 1-2 hours. The dosage must be personalized for each patient.
Administration of immunoglobulins at high dosage (in case of lack of response to cortisone)
- Gammaglobulins: immunoglobulins to be administered in high doses (for severe forms of thrombocytopenia). The drug exerts its therapeutic activity by slowing down the process of destruction of platelets. For dosage, consult your doctor.
- Anti-Rh immunoglobulins: the administration of these drugs is indicated for patients suffering from refractory thrombocytopenia; occurs at an indicative dose of 10-30 mcg/kg per day, for 1-3 consecutive days. This treatment is indicated almost exclusively for Rh positive patients
- Azathioprine (e.g. Azatiopirina, Immunoprin): immunosuppressant drug for the immune system, indicated in the treatment of thrombocytopenia to reduce the administration of steroids, whose long-term side effects could be quite important; indicatively, take azathioprine at a dose of 100 mg per day for 30 days, subsequently followed by 50 mg/day. It is observed that patients treated with this drug react positively in 60% of cases. The drug, if taken at the doses indicated by the doctor, does not cause significant side effects.
- Cyclophosphamide (e.g. Endoxan Baxter, bottle or tablets): is an alkylating and immunosuppressive agent also used in therapy for the treatment of autoimmune thrombocytopenia. The indicative dose involves taking the active ingredient at a dose of 50 mg per day; boluses of 800-1000 mg IV/3 weeks.
- Ciclosporin (e.g. Sandimmun Neoral): second-line drug for the treatment of immunological thrombocytopenias. It is recommended to take 3mg/kg of drug per day; the effectiveness of this drug is still doubtful.
- Rituximab (e.g. MabThera): is a monoclonal antibody used in therapy for the treatment of immunological thrombocytopenia. For dosage: consult your doctor.
- Eltrombopag (e.g. Revolade): the drug is indicated for the treatment of autoimmune thrombocytopenic purpura, a variant of thrombocytopenia in which the lack of thrombocytes is due to peripheral destruction of the same. Eltrombopag is an agonist of thrombopoietin receptors, a drug that promotes the formation of platelets: in other words, the drug increases the possibility of increasing the platelet count by reducing the risk of bleeding.