How Thrombocytopenia Is Treated

Thrombocytopenia is a diagnosis of having too few platelets in the blood.

Someone with thrombocytopenia may not have any symptoms, but sometimes people with thrombocytopenia may experience bleeding that is difficult to stop, bruising, tiny pinpoint red spots on the skin, or blood in the urine or stool.

Treating thrombocytopenia depends upon its severity and the condition that is causing it. If thrombocytopenia requires treatment, this is often done by fixing the underlying disorder. 

Observation

If thrombocytopenia is mild and is not causing any symptoms, it may not require any treatment. Continued monitoring of platelet counts and reporting any symptoms of bleeding or bruising may be the only intervention that is required.

Medication Avoidance

If thrombocytopenia is due to a reaction after taking a medication, stopping that medication may be the only treatment required. It may also be necessary to avoid or use with caution other medications that affect platelet function.

Some of the most common medications that may need to be discontinued or avoided include:

• Heparin
• Aspirin
• Ibuprofen
• Naproxen
• Blood thinners such as warfarin, Eliquis, or Xarelto
• Plavix

Prescription medications should never be discontinued without the guidance or instruction of the healthcare provider who prescribed it. 

Prescription Medications

Depending upon the underlying cause leading to the development of thrombocytopenia, multiple prescription medication treatments may be prescribed.

Steroids

Steroids are often given when thrombocytopenia occurs due to an autoimmune disorder or abnormal destruction of platelet cells by the immune system. Giving steroids decreases the immune system’s reaction and keeps the immune system from attacking the platelets.

Steroids can be given through an intravenous infusion or can be taken orally in pill form. They are typically tapered down over a few days or weeks as platelet counts improve.

Immune Globulin

Immune globulin (IVIG) is an intravenous infusion that can be given to slow down the immune system’s destruction of platelets. IVIG may be given in combination with steroids or as second-line therapy if steroids alone don’t work well enough to increase platelet counts.

Antibody Therapy

An antibody infusion called Rituxan can be infused to help improve platelet counts. Rituxan works by helping the immune system stop destroying platelets abnormally. This infusion can be given weekly for a few weeks to improve platelet counts.

Platelet-Boosting Medications

Instead of decreasing the immune system’s destruction of platelets, these medications work by increasing platelet production in the bone marrow. Examples of these medications include Promacta (eltrombopag) and Nplate (romiplostim).

Platelet Transfusion

Giving an infusion of donated platelets may be necessary for instances of severe thrombocytopenia and bleeding or with a need for emergent surgery. A unit of platelets can increase platelet counts by 30,000 to 60,000 per deciliter of blood.

However, platelets should not be transfused in thrombocytopenia caused by the medication Heparin, as a platelet transfusion can lead to greater complications.

Surgical Options

If nonsurgical treatments such as steroids, immune globulin infusions, and antibody infusions are not effective in increasing platelet counts, a splenectomy may be needed. During a splenectomy, a surgeon removes the spleen from the body.

The spleen is the location that platelets are removed from the body when being attacked by the immune system, and removing the spleen may significantly improve platelet counts. However, there are risks associated with surgery, and a splenectomy increases the risk of future infections.

Lifestyle Changes

Dietary Changes

Sometimes low platelet counts can be associated with low vitamin B12 or folate levels. Increasing these nutrients in the diet may improve platelet counts.

Avoiding Alcohol

If low platelet counts are caused by heavy alcohol use, avoiding alcohol completely may be necessary. Talk to your healthcare team to discuss prevention of withdrawal symptoms if alcohol use has been a chronic problem.

Decreasing Bleeding Risk

If platelets are low, certain activities may increase the risk of bleeding. Taking proper precautions to prevent injury may be necessary. Some of these may include:

• Wearing a helmet when riding a bike or scooter
• Wearing a seatbelt when riding in a car
• Avoiding high-contact sports if the spleen is enlarged or if platelets are low
• Wearing gloves when working with sharp objects 

A Word From Verywell

Having low platelet counts may come with a lot of worry about the potential risk of bleeding. However, having low platelet counts doesn’t always come with problems.

If platelets are low enough and require some form of treatment, multiple options are available, from oral and intravenous medications, to surgical options. Talk to your healthcare team about what options are best for you in treating thrombocytopenia.

Be sure to seek emergency treatment if you have low platelets and are experiencing bleeding or are having difficulty stopping bleeding.