General: Thrombocytopenia usually improves after treating the underlying cause. In some cases, medications or surgery can help treat chronic thrombocytopenia. If bleeding is severe, some patients may require a blood transfusion. If the condition is drug-induced, the patient will be advised to stop taking the medication. Type II HIT requires immediate discontinuation of heparin and administration of an alternative anticoagulant (like lepirudin, bivalirudin, argatroban or danaparoid).
Blood transfusion and plasma exchange: If patients experience severe bleeding, they may receive blood transfusions with red blood cells. Platelet concentrates are given to treat severe thrombocytopenia (that causes severe bleeding), especially those related to cancer or chemotherapy. Thrombotic thrombocytopenic purpura often requires emergency treatment with plasma exchange therapy or therapeutic plasmapheresis. With the development of plasmapheresis about 80-90% of individuals with TTP are able to recover.
Medications: Individuals who have idiopathic thrombocytopenic purpura, have been treated with medications that block the antibodies that attack platelets, such as corticosteroids (like prednisone), or medications that suppress the immune system to reduce antibody formation, such as cyclophosphamide (Cytoxan®) or azathioprine (Imuran®).
Alternative anticoagulants: Type II HIT requires immediate discontinuation of heparin and administration of an alternative anticoagulant (like lepirudin, bivalirudin, argatroban or danaparoid). Lepirudin (Refludan®) is approved by the U.S. Food and Drug Administration (FDA) for anticoagulation for patients with heparin-induced thrombocytopenia and heparin-induced thrombosis. Bivalirudin (Angiomax®) is FDA-approved for use in patients undergoing coronary angioplasty with unstable angina and concomitant aspirin therapy. Argatroban (Argatroban®) is FDA-approved for the prevention or treatment of thrombosis in patients who have type II HIT. Danaparoid (Orgaran®) is FDA-approved for the prevention of deep vein thrombosis after hip surgery, although it is approved in some countries for the treatment of type II HIT.
Surgery: In severe cases a surgeon may remove the spleen (splenectomy) to relieve symptoms or to help improve chronic idiopathic thrombocytopenic purpura that does not respond to corticosteroids.
Unclear or conflicting scientific evidence
Berberine: In limited available study, berberine has been shown to significantly increase platelet production in individuals with thrombocytopenia both as monotherapy and adjunctive therapy to prednisolone.
Avoid if allergic or hypersensitive to berberine, to plants that contain berberine (Hydrastis canadensis (goldenseal), Coptis chinensis (coptis or goldenthread), Berberis aquifolium (Oregon grape), Berberis vulgaris (barberry), and Berberis aristata (tree turmeric)), or to members of the Berberidaceae family. Avoid in newborns due to potential for increase in free bilirubin, jaundice and development of kernicterus. Use cautiously with heart disease, gastrointestinal disorders, hematologic (blood) disorders, leucopenia, kidney disease, liver disease, respiratory disorders, cancer, hypertyraminemia, diabetes or hypotension (low blood pressure). Use cautiously in children due to lack of safety information. Use cautiously in individuals with high exposure to sunlight or artificial light. Use cautiously for longer than eight weeks due to theoretical changes in bacterial gut flora. Use cautiously if taking anticoagulants (blood thinners), antihypertensives (blood pressure lowering agents), sedatives, anti-inflammatories, medications metabolized by CYP P450 3A4 including cyclosporin, or any prescription medications. Avoid if pregnant or breastfeeding due to potential for crossing placenta, stimulating the uterus (based on historical use) or transferring to breast milk.
Dong quai: Poor-quality study has reported benefits of Dong quai in patients diagnosed with idiopathic thrombocytopenic purpura (ITP). However, these patients were not compared to individuals who were not receiving Dong quai, and therefore the results can only be considered preliminary.
Avoid if allergic to Angelica radix or members of the Aplaceae/Umbelliferae family (like anise, caraway, carrot, celery, dill or parsley). Dong quai's safety in medicinal doses is unknown. There are no reliable long-term studies of side effects. Most precautions are based on theory, laboratory research, tradition, or isolated case reports. Avoid if pregnant due to possible hormonal and anticoagulant/anti-platelet properties. Avoid if breastfeeding due to insufficient scientific evidence of safety.
Ginseng: Combination herbal products containing ginseng may help treat refractory idiopathic thrombocytopenic purpura, a blood disorder that does not respond well to treatment. Studies that use ginseng alone are needed.
Avoid if allergic to plants in the Araliaceae family. There has been a report of a serious life-threatening skin reaction, possibly caused by contaminants in ginseng formulations.
Licorice: Early study has suggested that recombinant roasted licorice decoction combined with low-dose glucocorticoids may be more effective than glucocorticoids alone in treating idiopathic thrombocytopenic purpura. This combination has also shown a lower adverse effect rate than glucocorticoids alone.
Avoid with a known allergy to licorice, any component of licorice, or any member of the Fabaceae (Leguminosae) plant family. Avoid licorice with congestive heart failure, coronary heart disease, kidney or liver disease, fluid retention, high blood pressure, hormonal abnormalities, or if taking diuretics. Licorice can cause abnormally low testosterone levels in men or high prolactin or estrogen levels in women. This may make it difficult to become pregnant and may cause menstrual abnormalities.
Melatonin: Increased platelet counts after melatonin use has been observed in patients with thrombocytopenia. Stimulation of platelet production (thrombopoeisis) has been suggested but not clearly demonstrated. Additional research is necessary in this area.
Based on available studies and clinical use, melatonin is generally regarded as safe in recommended doses for short-term use. There are rare reports of allergic skin reactions after taking melatonin by mouth. Melatonin has been linked to a case of autoimmune hepatitis. Melatonin supplementation should be avoided in women who are pregnant or attempting to become pregnant, based on possible hormonal effects. High levels of melatonin during pregnancy may increase the risk of developmental disorders. In animal studies, melatonin is detected in breast milk and therefore should be avoided during breastfeeding. In men, decreased sperm motility and decreased sperm count are reported with the use of melatonin.
Individuals who have already experienced drug-induced thrombocytopenia should avoid exposure to the medication again. Patients who experienced HIT or HAT may experience thrombocytopenia if they are exposed to trace amounts of heparin (such as heparin-coated plastics that are used in hospitals).
If a qualified healthcare provider has determined that a patient is at risk for developing thrombocytopenia, the patient may be advised not to take aspirin because it impairs platelet function.