Thrombocytopenia medical therapy

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


The treatment of thrombocytopenia depends on the underlying cause.


Supportive measures

  • Platelet transfusion

Treatment of the underlying cause

  • Viral
    • Anti-viral medications
    • Hydration and supportive measures
  • Drug-induced
    • Discontinuation of the offending agent
    • Antidote for the offendating agents
  • Thrombotic microangiopathy[1]
    • Plasma exchange
    • Fresh frozen plasma
  • Sepsis
    • Antibacterial agents
    • Antiviral agents
    • Antifungal 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.


  1. Li QY, Yu F, Zhou FD, Zhao MH (2016). "Plasmapheresis Is Associated With Better Renal Outcomes in Lupus Nephritis Patients With Thrombotic Microangiopathy: A Case Series Study". Medicine (Baltimore). 95 (18): e3595. doi:10.1097/MD.0000000000003595. PMC 4863807. PMID 27149490.
  2. Baluom M, Grossbard EB, Mant T, Lau DT (2013). "Pharmacokinetics of fostamatinib, a spleen tyrosine kinase (SYK) inhibitor, in healthy human subjects following single and multiple oral dosing in three phase I studies". Br J Clin Pharmacol. 76 (1): 78–88. doi:10.1111/bcp.12048. PMC 3703230. PMID 23190017.

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