From the Guidelines
Thrombocytopenia is primarily caused by decreased platelet production, increased platelet destruction, or abnormal platelet sequestration, with immune thrombocytopenia (ITP) being a leading cause of increased platelet destruction, as noted in the 2019 American Society of Hematology guidelines 1. The causes of thrombocytopenia can be categorized into:
- Decreased platelet production, which occurs in bone marrow disorders like leukemia, aplastic anemia, vitamin B12 or folate deficiency, and chemotherapy or radiation exposure.
- Increased platelet destruction, which happens in immune thrombocytopenia (ITP), heparin-induced thrombocytopenia (HIT), disseminated intravascular coagulation (DIC), thrombotic thrombocytopenic purpura (TTP), and hemolytic uremic syndrome (HUS), as discussed in the 2019 guidelines 1.
- Abnormal platelet sequestration, which occurs when an enlarged spleen traps platelets, as seen in liver disease with portal hypertension. Medications that can cause thrombocytopenia include heparin, quinine, sulfonamides, certain antibiotics, and anticonvulsants, as mentioned in the international consensus report on ITP 1. Infections like HIV, hepatitis C, and sepsis can also decrease platelet counts. Pregnancy complications like preeclampsia and HELLP syndrome can cause thrombocytopenia, highlighting the need for careful evaluation and management of patients with thrombocytopenia, as emphasized in the 2019 guidelines 1. The underlying mechanism of thrombocytopenia is crucial in determining the appropriate treatment approach, which may include stopping offending medications, treating underlying infections, administering corticosteroids for immune-mediated cases, or using thrombopoietin receptor agonists to stimulate platelet production in certain conditions, as recommended in the 2019 American Society of Hematology guidelines 1.
From the FDA Drug Label
ALVAIZ is a prescription medicine used to treat: adults and children 6 years of age and older with low blood platelet counts due to persistent or chronic immune thrombocytopenia (ITP), when other medicines to treat ITP or surgery to remove the spleen have not worked well enough adults with low blood platelet counts due to chronic hepatitis C virus (HCV) infection before and during treatment with interferon. The causes of thrombocytopenia mentioned in the drug label are:
- Immune thrombocytopenia (ITP)
- Chronic hepatitis C virus (HCV) infection
- Severe aplastic anemia (SAA) 2 and 3
From the Research
Causes of Thrombocytopenia
Thrombocytopenia can occur due to various reasons, including:
- Decreased platelet production 4, 5, 6
- Increased destruction of platelets 4, 5, 6
- Splenic sequestration 4, 6
- Dilution or clumping of platelets 4
- Infections 5
- Malignancy 5
- Liver disease 5
- Autoimmune disorders 5
- Disseminated intravascular coagulation 5
- Pregnancy 5
- Medications 4, 5, 7
- Coagulation disorders 5
- Chemotherapy-induced thrombocytopenia 7
- Bone marrow failure or infiltration 8
Specific Conditions Associated with Thrombocytopenia
Certain conditions can increase the risk of thrombocytopenia, such as:
- Antiphospholipid syndrome 4
- Heparin-induced thrombocytopenia 4
- Thrombotic microangiopathies 4
- Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome 4
- Immune thrombocytopenia 4
- Drug-induced thrombocytopenia 4
- Hepatic disease 4
- Acute and chronic leukemias 8
- Myelodysplastic syndromes (MDS) 8
- Aplastic anemia 8
- Breast and prostate cancer 8