Pediatric Thrombocytopenia Treatment & Management

  • Author: Susumu Inoue, MD; Chief Editor: Max J Coppes, MD, PhD, MBA   more...
 
Updated: Apr 19, 2010
 

Medical Care

No treatment is necessary for reactive thrombocytosis. Rarely, in patients who have reactive thrombocytosis and a known risk factor for thrombosis, such as factor V Leiden mutation, the thrombotic risk may be increased. However, no information is currently available regarding the magnitude of the risk. Therefore, one should consider each case individually for prophylaxis of thrombosis. In vasculitis syndrome with thrombocytosis (in particular, in Kawasaki syndrome), treatment with aspirin is recommended (see Kawasaki Disease).[38] In primary thrombocytosis, prophylactic use of antithrombotic agents has not been well delineated. In general, platelet-lowering agents have been recommended for high-risk patients (all adults) with an increased cardiovascular risk, have a previous history of thrombosis, or who are older than 60 years (see Medication).

In adult patients with posttrauma thrombocytosis (platelet count >1 million), treatment with aspirin showed no effect in the rate of mortality, complications, and length of ICU stay.[39] However, this is a retrospective, nonrandomized study; thus, it does not answer whether aspirin is useful in this group of patients.

In patients in whom primary thrombocytosis is strongly suspected, laboratory studies mentioned in the previous section and evaluation of family members may be needed to confirm the diagnosis. Morphologic and cytogenetic examination of bone-marrow cells and marrow reticulin stains should be repeated in patients with a changing hematologic picture (refer patients to a hematologist). Evolution of primary thrombocytosis to frank acute myeloblastic leukemia (AML), myelofibrosis/agnogenic myeloid metaplasia (AMM), or myelodysplastic syndrome (MDS) has been documented in adults and represents a progression of disease. The prognosis after this progression is poor. However, successful allogeneic bone-marrow or stem-cell transplantation has been reported in patients who developed AML/MDS and/or myelofibrosis. Therefore, keep this modality in mind when treating primary thrombocytosis.

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Consultations

A persistent increase in neutrophil counts with immature forms (eg, metamyelocytes, myelocytes), persistent increase in basophils and eosinophils, and splenomegaly suggest a chronic myelocytic leukemia (CML). Kastan et al described 2 children whose clinical findings and blood counts best fit essential thrombocytosis (ET) but whose bone-marrow cytogenetic analyses showed the presence of the Philadelphia (Ph1) chromosome.[40] Both of these patients presented with platelet counts in excess of 2000 X 109/L.

A persistent increase in the hematocrit (with or without a change in the WBC count) with thrombocytosis suggests polycythemia vera. The image below shows suggested workup algorithm for thrombocytosis.

Algorithm for thrombocytosis workup and potential Algorithm for thrombocytosis workup and potential need for medication.

One should consult a hematologist if a workup for ET is needed. Older children with thrombocytosis with thrombosis (suspected or demonstrated) or a history of thrombosis, increased bleeding tendency despite thrombocytosis, or splenomegaly must promptly be referred to a hematologist. Also, a family history of thrombocytosis requires consultation with a hematologist and geneticist because a genetic work-up is necessary.

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Activity

No medical reason warrants the limitation or encouragement of activity in a child with thrombocytosis. A child with a substantially enlarged spleen (usually caused by essential or familial thrombocythemia) requires necessary precautions regarding their activity to prevent splenic rupture.

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Contributor Information and Disclosures
Author

Susumu Inoue, MD  Professor of Pediatrics and Human Development, Michigan State University College of Human Medicine; Clinical Professor of Pediatrics, Wayne State University School of Medicine; Director of Pediatric Hematology/Oncology, Associate Director of Pediatric Education, Department of Pediatrics, Hurley Medical Center

Susumu Inoue, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Hematology, American Society of Pediatric Hematology/Oncology, International Society for Experimental Hematology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

J Martin Johnston, MD  Associate Professor of Pediatrics, Mercer University School of Medicine; Director of Pediatric Hematology/Oncology, Backus Children's Hospital; Consulting Oncologist/Hematologist, St Damien's Pediatric Hospital

J Martin Johnston, MD is a member of the following medical societies: American Academy of Pediatrics and American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

James L Harper, MD  Associate Professor, Department of Pediatrics, Division of Hematology/Oncology and Bone Marrow Transplantation, Associate Chairman for Education, Department of Pediatrics, University of Nebraska Medical Center; Assistant Clinical Professor, Department of Pediatrics, Creighton University; Director, Continuing Medical Education, Children's Memorial Hospital; Pediatric Director, Nebraska Regional Hemophilia Treatment Center

James L Harper, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for Cancer Research, American Federation for Clinical Research, American Society of Hematology, American Society of Pediatric Hematology/Oncology, Council on Medical Student Education in Pediatrics, and Hemophilia and Thrombosis Research Society

Disclosure: Nothing to disclose.

Helen SL Chan, MBBS, FRCP(C), FAAP  Senior Scientist, Research Institute; Professor, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Canada

Helen SL Chan, MBBS, FRCP(C), FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association for Cancer Research, American Society of Hematology, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Chief Editor

Max J Coppes, MD, PhD, MBA  Senior Vice President, Center for Cancer and Blood Disorders, Children's National Medical Center; Professor of Medicine, Oncology, and Pediatrics, Georgetown University School of Medicine; Clinical Professor of Pediatrics, George Washington University School of Medicine and Health Sciences

Max J Coppes, MD, PhD, MBA is a member of the following medical societies: American Association for Cancer Research, American Society of Pediatric Hematology/Oncology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

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Algorithm for thrombocytosis workup and potential need for medication.
 
 
 
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