Thrombocytopenia and Acquired Hemolytic Anemia: Treatment Options Explained

Thrombocytopenia and acquired hemolytic anemia?

Hello Dr.
Gao: In 2019, I discovered many small bruises on my body.
After an examination at a clinic, it was found that my platelet count was only 9,000.
I was urgently sent to a large hospital's emergency department, and after being hospitalized for observation, I was diagnosed with thrombocytopenia and hemolytic anemia.
Over the past four years since my illness, I have been hospitalized for treatment due to low platelet counts (below 20,000) in the first two years.
In the last two years, I have been controlling it with "Dexamethasone" (a corticosteroid).
However, I have noticed that my platelet count fluctuates between normal and low in recent months.
My doctor has informed me that a splenectomy may be an option.
Since I have no understanding of this, and there is limited literature available for reference, I would like to ask Dr.
Gao if, as my doctor said, a splenectomy is the best choice? Recently, due to persistently low platelet counts, I feel like I am nearing depression from this long illness, so I am reaching out to Dr.
Gao for advice.
Thank you for your response.
Additionally, I still do not know the underlying cause of my condition, as I have not undergone a bone marrow biopsy; all tests have been blood tests.

Miss Lin, 40~49 year old female. Ask Date: 2022/12/08

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Splenectomy is indeed one of the treatment options for refractory thrombocytopenia.
You may want to consult a second physician to re-evaluate any underlying possible autoimmune diseases.
If it is confirmed to be immune thrombocytopenia, in addition to corticosteroids and surgical splenectomy, there are other medication options available, including romiplostim, which has shown good treatment results.
You can discuss this with your physician.
The Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare, is concerned about you.

Reply Date: 2022/12/08

More Info

Thrombocytopenia and acquired hemolytic anemia are complex conditions that can significantly impact a patient's quality of life. Understanding these conditions, their causes, and treatment options is crucial for effective management.

Thrombocytopenia refers to a lower-than-normal platelet count in the blood, which can lead to increased bleeding and bruising. In your case, a platelet count of 9,000 is critically low and can pose serious risks, including spontaneous bleeding. The causes of thrombocytopenia can be varied, including bone marrow disorders, increased destruction of platelets (as seen in conditions like immune thrombocytopenic purpura, or ITP), and splenic sequestration, where the spleen traps platelets.

Acquired hemolytic anemia occurs when red blood cells are destroyed faster than they can be produced. This can be due to various factors, including autoimmune disorders, infections, certain medications, or underlying diseases. The combination of thrombocytopenia and hemolytic anemia can complicate the clinical picture, as both conditions can lead to fatigue, weakness, and an increased risk of bleeding.

In your situation, the treatment options can vary based on the underlying cause of your conditions. Since you mentioned that you have been on "康素龍錠培尼皮質醇" (prednisone), which is a corticosteroid, it suggests that your doctor suspects an autoimmune component to your thrombocytopenia and hemolytic anemia. Corticosteroids can help reduce the immune system's attack on platelets and red blood cells, but they may not always be sufficient.

Splenectomy, or the surgical removal of the spleen, is often considered in cases of ITP or when the spleen is contributing to the destruction of platelets. The spleen plays a role in filtering blood and removing old or damaged cells, including platelets. By removing the spleen, it is possible to increase platelet counts in some patients. However, this procedure is not without risks, and it may not be suitable for everyone. It is essential to weigh the potential benefits against the risks, including the possibility of infections post-splenectomy, as the spleen helps fight certain infections.

Before considering splenectomy, it is crucial to have a thorough evaluation, including a bone marrow biopsy, to rule out other causes of your thrombocytopenia and hemolytic anemia. This test can provide valuable information about the production of blood cells in your bone marrow and help identify any underlying disorders.

In addition to splenectomy, other treatment options may include:
1. Immunosuppressive therapy: If your condition is autoimmune in nature, additional immunosuppressive medications may be considered to help control the immune response.

2. Intravenous immunoglobulin (IVIG): This treatment can help raise platelet counts temporarily by reducing the immune system's attack on platelets.

3. Rituximab: This monoclonal antibody can be effective in treating certain types of autoimmune thrombocytopenia.

4. Platelet transfusions: In cases of severe bleeding, platelet transfusions may be necessary to quickly increase platelet counts.

5. Supportive care: This includes monitoring your blood counts regularly, managing symptoms, and addressing any psychological impacts, such as anxiety or depression, that may arise from living with these conditions.

It is understandable that dealing with these health issues can lead to feelings of frustration and sadness. It is essential to communicate openly with your healthcare provider about your concerns and symptoms. They can provide support and may refer you to a mental health professional if needed.

In conclusion, while splenectomy may be a viable option for some patients, it is essential to have a comprehensive evaluation to determine the best course of action for your specific situation. Discussing all available options with your healthcare provider will help you make an informed decision that aligns with your health goals and quality of life.

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