Thrombocytopenia: Therapy

It is not the platelet count but the clinical aspect, whether or not there is a hemorrhagic diathesis (pathologically increased bleeding tendency), that determines therapy (see table below).

Furthermore, it is important whether it is an isolated thrombocytopenia with otherwise normal values of hemoglobin (Hb) and leukocytes (incl. differential blood count), or a thrombocytopenia that is part of a two- or three-line cytopenia (dicytopenia or pancytopenia). In pancytopenia (synonym: tricytopenia), there is a severe reduction of all three rows of cells in the blood. Thus, anemia (anemia), leukopenia (reduced number of white blood cells (leukocytes) in the blood compared to the norm), and thrombocytopenia exist simultaneously.

Grade Bleeding Description Therapy
0 none
  • No bleeding signs
  • Progress monitoring
1 low
  • Few petechiae (≤ 100 total) and/or> 5 large hematomas (≤ 3 cm in diameter).
  • No mucosal bleeding
  • Tight controls
  • Wait for spontaneous progression
2 mild
  • Many petechiae (> 100 total) and/or > 5 large hematomas (> 3 cm in diameter).
  • No mucosal bleeding
  • Progress monitoring,
  • Therapy according to individual decision
3 Medium
  • Mucosal bleeding (nosebleeds, gingival bleeding, oropharyngeal bleeding foci, gastrointestinal bleeding, menorrhagia) that does not require immediate medical evaluation or intervention
  • Lifestyle with increased risk of injury
  • First-line treatment* . Objective:
    • Achieve grade 1 or 2; not necessarily achieve normalization of platelet count.
4 heavy
  • Mucosal hemorrhage or suspected internal bleeding requiring immediate medical evaluation or intervention

* First-line treatment:

HIT (heparin-induced thrombocytopenia)

  • Most common form of drug-induced thrombocytopenia.
HIT type I HIT type II
Affected group Sensitized patients only Non-sensitized patients also
Frequency 10-25 % 0.5-3 %(UFH: NMH* = 9:1)
Mechanism Heparin-platelet interaction (dose-dependent). Antibody-induced platelet activation (dose-independent).
Onset Day 1-5 after initiation of heparin therapy. Day 5-20 after initiation of heparin therapyOn re-exposure for a few hours.
Platelets Mostly > 100,000/µl Mostly 40-60,000/µl(drop > 50% of baseline)
Complications / Thromboembolism
Diagnostics Diagnosis of exclusion HIT antibodies (resulting in massive thrombin formation!).
Therapy No therapy required; self-limiting course; heparin can be continued Discontinue heparin immediately if suspected (then normalize values)Anticoagulation with lepirudin, danaparoid sodium, or argatrobanPatients must not receive heparin in the future!

* UFH: unfractionated heparinNMH: low-molecular-weight heparin.