Medicines to Treat Thrombocytopenia

Definition

The platelet count in the blood is a measure of blood clotting capacity. Thrombocytopenia (or thrombocytopenia) delineates a clinical picture characterized by a number of circulating platelets less than 150,000 units per mm3 of blood, detected by the blood count performed with at least two different anticoagulants. In a healthy adult, the blood platelet count should be around 150,000 to 400,000 units per mm3.

Causes

Thrombocytopenia can be classified according to the underlying cause:

From destruction of thrombocytes → severe bacterial infections, abuse of chemotherapy and antibiotics, systemic diseases
From excessive consumption of platelets → vitamin B12 and B9 deficiency, recurrent infections, megaloblastic anemia, eczema, disseminated intravascular coagulation
From thrombocyte sequestration → liver cirrhosis

Risk factors: leukemia, excessive intake of NSAIDs, heparins, diuretics, platelet inhibitors (eg Eptifibatide)

Symptoms

When the values of circulating platelets are low (between 50,000 and 150,000 units / mm3) but not too low, thrombocytopenia can be asymptomatic. When the values drop considerably, the patient may complain of bleeding, epitaxis, bruising, gastrointestinal and urinary haemorrhages, menorrhagia, cerebral haemorrhages.

Complications: platelet hemorrhagic syndrome

The information on Thrombocytopenia - Medicines 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 - Medicines to Treat Thrombocytopenia.

Medicines

Mild thrombocytopenia - when the platelet count is slightly below the normal range (<150,000 units / mm3) - does not require special treatment or care, as the condition tends to stabilize on its own, except clearly , for patients who complain of appreciable symptoms. The same goes for thrombocytopenia gravidarum: in many pregnant women (about 10%) there is a significant alteration in the platelet count which, generally, does not harm either the mother or the child, and tends to return to normal after the birth of the child.
When thrombocytopenia becomes important, it is necessary to intervene with drug therapy and / or a blood transfusion: the therapeutic approach - it should be remembered - should be undertaken only after identifying the triggering cause. To give an example, thrombocytopenia can depend from the administration of some 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 by mouth or intravenously (to counteract bleeding)
Intravenous immunoglobulin administration (to treat thrombocytopenia dependent on an abnormal immune reaction)
Platelet transfusion: Reserved for patients with obvious bleeding and a high risk of bleeding
Removal of the spleen: reserved for extreme cases, in which drugs have reported no observable benefit

The following are the classes of drugs most used in the 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 state of health of the patient and his response to 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 symptoms. The doses given below are indicative: consult your doctor before taking the drug.

Prednisone (eg. 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 in pregnancy: in this case, it is indicatively recommended to take a dose of active equal to 1mg / kg of extra-fatal body weight. The treatment must be maintained at the minimum dose necessary to avoid bleeding complications, that is to say, avoiding that the platelets fall below the value of 50,000 units / mm3.
Dexamethasone (eg Decadron, Soldesam): dexamethasone, thanks to its anti-haemorrhagic effect, is indicated to block bleeding 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 (eg 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 (eg 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 can be considered, to avoid the side effects that long-term therapy with steroid drugs would entail.

Enzyme therapy:

Miglucerase (eg Cerezyme): this is a drug indicated for enzyme therapy, where thrombocytopenia is a characteristic symptom of important diseases such as Gaucher syndrome. It is not possible to report an indicative dosage, since the precise dosage must be personalized according to the patient. However, the drug is available in powder for concentrate (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 high-dose immunoglobulins (in case of non-response to cortisone)

Gammaglobulins: immunoglobulins to be administered in high dosage (for severe forms of thrombocytopenia). The drug exerts its therapeutic activity by slowing down the process of destruction of platelets. For the posology, consult your doctor.
Anti-Rh immunoglobulins: the administration of these drugs is indicated for patients with refractory thrombocytopenia; occurs at the indicative dose of 10-30 mcg / kg per day, for 1-3 consecutive days. This treatment is indicated almost exclusively for Rh positive patients

Immunosuppressive drugs

Azathioprine (eg. Azathiopirina, Immunoprin): immunosuppressant drug of 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, followed subsequently by 50 mg / day. It is observed that patients treated with this drug react positively in 60% of cases. The drug, if taken at all times. doses indicated by the doctor, does not cause significant side effects.
Cyclophosphamide (eg Endoxan Baxter, bottle or tablets): is an alkylating and immunosuppressive agent also used in therapy for the treatment of autoimmune thrombocytopenia. The indicative dose is to take the active ingredient at a dose of 50 mg per day; boluses of 800-1000 mg i.v./3 weeks.
Ciclosporin (eg Sandimmun Neoral): second-line drug for the treatment of immunological platelet disorders. It is recommended to take 3mg / kg of the drug per day; the effectiveness of this drug is still doubtful.
Rituximab (eg. MabThera): is a monoclonal antibody used in therapy for the treatment of immunological thrombocytopenia. For the posology: consult your doctor.
Eltrombopag (eg 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 their peripheral destruction. 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 reducing the risk of bleeding.