What is the primary treatment for thrombocytopenia in a patient with intestinal hookworm infestation?

Management of Thrombocytopenia in Patients with Hookworm Infection

The primary treatment for thrombocytopenia in patients with intestinal hookworm infestation is albendazole 400 mg as a single dose to eliminate the underlying parasitic infection. 1

Pathophysiology and Diagnosis

• Hookworm infection (Ancylostoma duodenale and Necator americanus) can cause thrombocytopenia through blood loss in the intestinal tract, leading to iron deficiency anemia and altered platelet parameters 2, 3
• Diagnosis is made through concentrated stool microscopy to identify hookworm eggs 1
• Patients may present with abdominal pain, diarrhea, and symptoms of anemia due to chronic blood loss 4, 5
• Hookworm infection has been associated with statistically significant lowering of mean platelet volume (MPV) and non-significant lower platelet counts 2

Treatment Algorithm

First-Line Treatment:

• Antiparasitic therapy: Albendazole 400 mg as a single oral dose is the treatment of choice for hookworm infection 1
• Alternative options include:
  • Mebendazole 500 mg as a single dose 1, 6
  • Mebendazole 100 mg twice daily for 3 days (for heavy infections) 6

Management of Associated Thrombocytopenia:

1. For mild thrombocytopenia (platelet count >50 × 10^9/L) without significant bleeding:

   • Observation after antiparasitic treatment is appropriate 7
   • Monitor platelet counts until resolution 1

2. For moderate thrombocytopenia (platelet count 30-50 × 10^9/L):

   • Antiparasitic treatment as above
   • Consider iron supplementation if iron deficiency anemia is present 4, 8
   • Monitor for bleeding symptoms 7

3. For severe thrombocytopenia (platelet count <30 × 10^9/L) or with active bleeding:

   • Immediate antiparasitic treatment
   • Consider corticosteroids or IVIg if immune-mediated thrombocytopenia is suspected 1
   • Blood transfusion may be necessary in cases of severe anemia 4, 5

Special Considerations

• Thrombocytopenia typically resolves after successful treatment of the hookworm infection 2, 3
• If thrombocytopenia persists after antiparasitic treatment, consider other causes such as immune thrombocytopenia (ITP) 1
• For patients with persistent thrombocytopenia after hookworm eradication:
  • Test for HCV and HIV as these can cause secondary thrombocytopenia 1
  • Consider bone marrow examination if thrombocytopenia persists without explanation 1, 7

Prevention of Reinfection

• Wear shoes when walking on potentially contaminated soil 1, 6
• Proper sanitation and sewage treatment 4, 8
• Handwashing before eating and after using the toilet 6, 4
• Avoid walking barefoot on affected soil or sand 1

Monitoring and Follow-up

• Repeat stool examination 2-4 weeks after treatment to confirm parasite clearance 1
• Monitor complete blood count to track resolution of thrombocytopenia 7
• For patients with severe thrombocytopenia or anemia, more frequent monitoring may be necessary until values normalize 1, 7

The key to successful management is treating the underlying hookworm infection, which will typically lead to resolution of the thrombocytopenia. If thrombocytopenia persists after effective antiparasitic treatment, further investigation for other causes should be pursued.