How Are Thrombocythemia and Thrombocytosis Treated?

Primary Thrombocythemia

This condition is considered less harmful today than in the past, and its outlook often is good. People who have no signs or symptoms don't need treatment, as long as the condition remains stable.

Taking aspirin may help people who are at risk for blood clots (aspirin thins the blood). However, you should talk with your doctor about using aspirin because it can cause bleeding. Doctors prescribe aspirin to most pregnant women who have primary thrombocythemia. This is because it doesn't have a high risk of side effects for the fetus.

Some people who have primary thrombocythemia may need medicines or medical procedures to lower their platelet counts.

Medicines To Lower Platelet Counts

You may need medicines to lower your platelet count if you:

• Have a history of blood clots or bleeding
• Have risk factors for heart disease, such as high blood cholesterol, high blood pressure, or diabetes
• Are older than 60
• Have a platelet count over 1 million

You'll need to take these medicines throughout your life.

Hydroxyurea. This is the most common platelet-lowering medicine to treat primary thrombocythemia. Hydroxyurea is used to treat cancers and other life-threatening diseases. It's most often given under the care of doctors who specialize in cancer or blood diseases. Patients on hydroxyurea are closely monitored.

Currently, hydroxyurea plus aspirin is the standard treatment for people who have primary thrombocythemia and are at high risk for blood clots.

Anagrelide. This medicine has been used to treat thrombocythemia. However, it doesn't seem to work as well as hydroxyurea. Anagrelide also has side effects, such as fluid retention, palpitations (pal-pi-TA-shuns), arrhythmias (ah-RITH-me-ahs), heart failure, and headaches.

Interferon alfa. This medicine does lower platelet counts, but 20 percent of patients can't handle its side effects. Side effects include a flu-like feeling, decreased appetite, nausea (feeling sick to the stomach), diarrhea, seizures, irritability, and sleepiness.

Doctors may prescribe this medicine to pregnant women who have primary thrombocythemia. This is because it's safer for a fetus than hydroxyurea and anagrelide.

Plateletpheresis

Plateletpheresis (PLATE-let-fe-REH-sis) is a procedure used to rapidly lower your platelet count. This procedure is used only for emergencies. For example, if you're having a stroke due to primary thrombocythemia, you may need plateletpheresis.

During this procedure, an intravenous (IV) needle that's connected to a tube is placed in one of your blood vessels to remove blood. The blood goes through a machine that removes platelets from the blood. The remaining blood is then put back into you through an IV line in one of your blood vessels.

One or two procedures may be enough to reduce your platelet count to a safe level.

Secondary Thrombocytosis

Secondary thrombocytosis is treated by addressing the condition that's causing it.

People who have secondary thrombocytosis usually don't need platelet-lowering medicines or procedures. This is because their platelets usually are normal (unlike in primary thrombocythemia). Also, their platelet counts often aren't high enough to put them at risk for blood clots or bleeding.

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