How do I Choose the Best Thrombocytopenia Treatment?

Thrombocytopenia, a condition diagnosed when there are too few platelets in the blood, is treated according to the reason for the low platelet count. This means there's not a lot of choice involved in picking the best treatment; the underlying cause instead serves to determine the appropriate treatment. The mainstay of thrombocytopenia treatment in the acute setting is the transfusion of platelets, a therapy particularly important if the patient is actively bleeding or needs surgery. Non-emergent situations in which thrombocytopenia is discovered often require further investigation to determine why the platelet count is low. Many diseases can cause thrombocytopenia, so it is important to understand why the platelet count is low before choosing a thrombocytopenia treatment.

Platelets are small disc-like cells that lack nuclei. They are made in the bone marrow and circulate in the blood. The primary function of platelets is to create a plug at the site of an injury. Essentially, this means platelets clump at the site of cellular damage, thus stopping the blood flow through small blood vessels and preventing excessive blood loss. Without enough platelets in the blood stream, a person has increased risk when bleeding from even a minor injury.

The number of platelets in the blood is typically checked as part of a complete blood count, a commonly performed laboratory test. The normal number of platelets found in human blood ranges from 150,000 to 450,000 per microliter. Thrombocytopenia is defined as a platelet count of less than 150,000 per microliter. If thrombocytopenia is identified, the next laboratory test ordered is often a peripheral smear of the blood to allow for microscopic examination of the components of the blood. If the only abnormal finding on the peripheral smear is a low platelet count, this piece of information narrows the differential diagnosis of the thrombocytopenia.

First, a number of medications have a side effect of lowering the platelet count. Heparin, a blood thinning agent, is one medication known to cause heparin-induced thrombocytopenia. In this case, the thrombocytopenia treatment would include stopping that specific medication.

Second, infection can decrease platelet counts. The thrombocytopenia treatment for this state would be to treat the underlying infection. If neither medication nor infection is causing the thrombocytopenia, an autoimmune process could be at work. Idiopathic thrombocytopenia, lupus, and rheumatoid arthritis can all cause an isolated low platelet count. Treatment for these diseases varies, but typically involves steroids or other immunosuppressive medications.

If schistocytes, or fragmented red blood cells, are seen on the peripheral smear, a different thrombocytopenia treatment strategy is required. Serious conditions such as disseminated intravascular coagulopathy or thrombotic thrombocytopenia purpura could be present. The treatment for these is to identify other comorbid conditions and to consider performing a transfusion.

If the blood smear shows decreased counts of red blood cells, white blood cells, and platelets, this points to a general problem with the production of blood cells in the bone marrow. Patients with this finding often require a bone marrow biopsy for diagnosis. Conditions such as aplastic anemia, leukemia, and myelodysplastic syndrome can cause low platelet production. Thrombocytopenia treatment should then focus on treatment of the disease process suppressing the bone marrow production of platelets.