From the Guidelines
Steroids can cause a decrease in platelets, although this is an uncommon side effect, and the risk appears to be dose-dependent. Corticosteroids like prednisone are typically used to treat thrombocytopenia, but they can sometimes cause this condition as well 1. The mechanism involves either immune-mediated destruction of platelets or decreased platelet production. According to the American Society of Hematology 2019 guidelines, corticosteroids are recommended for adults with immune thrombocytopenia who have no or mild bleeding and platelet counts below 20 × 10^9/L to 30 × 10^9/L 1. However, prolonged corticosteroid use is discouraged, and there is no preference stated for the type of corticosteroid.
Some key points to consider:
- Steroid-induced thrombocytopenia typically develops within days to weeks of starting treatment and resolves after discontinuation of the medication.
- Patients taking steroids who experience unusual bruising, petechiae, prolonged bleeding from cuts, or spontaneous bleeding from the gums or nose should seek medical attention promptly.
- Regular blood count monitoring is recommended for patients on long-term steroid therapy.
- The risk of steroid-induced thrombocytopenia appears to be dose-dependent, with higher doses and longer treatment durations potentially increasing the likelihood of developing this side effect 1.
It is essential to weigh the benefits and risks of corticosteroid therapy in patients with thrombocytopenia, considering the potential for this uncommon but significant side effect 1.
From the Research
Steroids and Thrombocytopenia
- Steroids, such as corticosteroids, are commonly used to treat immune thrombocytopenia (ITP), a condition characterized by low platelet count 2, 3, 4.
- The effect of steroids on platelet count is complex and can vary depending on the individual and the specific steroid used 2, 4.
- Some studies suggest that steroids can increase platelet count in patients with ITP, particularly in those who are responsive to steroid treatment 2, 3.
- However, other studies have found that steroids may not have a significant impact on long-term platelet count response in patients with ITP 4.
Mechanism of Action
- Steroids may work by reducing the activation of platelets, which can help to increase platelet count in patients with ITP 2.
- Steroids may also help to ameliorate endothelial abnormalities, which can contribute to bleeding in patients with thrombocytopenia 5.
Side Effects
- Steroids can have significant side effects, including weight gain, mood changes, and increased risk of infection 6.
- Some patients may experience a decrease in platelet count after stopping steroid treatment, which can increase the risk of bleeding 6.