Thrombocytopenia medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]

Overview

The treatment of thrombocytopenia depends on the underlying cause.

Treatment

Drug-induced
- Discontinuation of the offending agent
- Antidote for the offendating agents

Pseudothrombocytopenia
- Use of calcium citrate instead of EDTA during blood collection

Immune thrombocytopenia purpura (ITP)
- Corticosteroids: These medications can take up to 48 hours to take effect. Steroids are first-line therapy for ITP. Adverse effects include infection, muscle loss, adipose deposition, cataracts, glaucoma, and Cushing’s syndrome.
- Intravenous immunoglobulin: This medication has an immediate effect, typically within hours. IV immunoglobulin is first-line therapy for ITP.
- Rituximab: This is a monoclonal antibody that targets CD20 on B cells and eliminates antibody-producing B cells. It is used as second-line therapy. Adverse effects include infections, hepatitis B reactivation, and progressive multifocal leukoencephalopathy.
- Fostamatinib: This is a spleen tyrosine kinase (SYK) inhibitor that functions by blocking signaling through the Fc receptor in B cells.^[2] Adverse effects include hypertension, hepatotoxicity, diarrhea, and neutropenia.
- Eltrombopag: This is a TPO receptor agonist and is third-line therapy. Liver tests must be monitored while taking eltrombopag. It can cause thrombosis.
- Romiplostim: This is a TPO receptor agonist and is third-line therapy. It can cause thrombosis.

References

Overview