Dr. Weyrich's Naturopathic Functional Medicine Notebook is a collection of information on topics of interest to Dr. Weyrich that may be of interest to the world wide audience. Due to limitations of time, not all information that Dr. Weyrich knows or would like to further research is published here. Dr. Weyrich welcomes financial contributions to support specific research topics, as well as copies of non-free access journal articles for him to review on a topic. Constructive criticism is also welcome.


Overview of Thrombocythemia and Thrombocytosis

Thrombocythemia and thrombocytosis are disorders in which an excessive number of platelets are present in the blood, which generally increases the tendency to form blood clots. There are a number of possible causes, and a good differential diagnosis is necessary prior to treatment. When the cause is unknown (idiopathic, essential, or primary), the condition is called thrombocythemia; when the condition demonstrated to be caused by some other disease or disorder (secondary or reactive), the condition is called thrombocytosis [NIH].

In most cases, thrombocythemia and thrombocytosis are asymptomatic, but there is increased risk of developing serious problems such as blood clots leading to stroke or other life-threatening conditions, especially in the case of thrombocythemia. However, most people with thrombocythemia have a normal life expectancy if properly treated [NIH]. The prognosis for people with thrombocytosis depends on the secondary condition that is causing the elevated platelet count.

Paradoxically, in some cases thrombocythemia may result in dysfunctional platelets that are ineffective in clotting, therefore leading to bleeding or bruising [NIH]; this may be associated with von Willebrand Disease. On the other hand, thrombocytosis usually produces platelets that have normal function

Naturopathic, Complimentary and Alternative treatments for thrombocythemia and thrombocytosis that are considered below include:

  • Nutrition

Etiology of Thrombocythemia and Thrombocytosis

  • Genetic (rare)
  • Idiopathic: bone marrow produces too many platelets for some unknown reason.
  • Secondary to cancer (35%). Often the first sign of cancer [NIH].
  • Secondary to blood loss or anemia (iron folate or B12 deficient; hemolytic) [NIH].
  • Secondary to pharmaceutical drugs [NIH].
  • Secondary to asplenia (surgical removal of the spleen) [NIH].
  • Secondary to connective tissue disorders [NIH].
  • Secondary to inflammatory bowel disease [NIH].
  • Secondary to infectious diseases such as TB [NIH].
  • Secondary to other causes of inflammation.
  • Secondary to physical activity (transitory) [NIH].
  • Secondary to excessive alcohol use (transitory) [NIH].

Diagnosis of Thrombocythemia and Thrombocytosis

  • Complete Blood Count (CBC) shows elevated platelet count
  • Peripheral blood smear.
  • Bone marrow aspiration or biopsy.
  • Genetic testing for JAK2, CALR, SF3B1, MPL, etc. mutations
  • von Willebrand factor testing
  • Rule out all secondary causes before diagnosing primary

Treatment of Thrombocythemia and Thrombocytosis

Please see conventional, complimentary and alternative medical treatments for important background information regarding the different types of medical treatments discussed below.

Treatments for Thrombocytosis (Conventional, Naturopathic, Complimentary and Alternative)

  • Treat the cause.
  • Monitor for signs or symptoms directly arising from excess platelets, such as excess clotting or bleeding, and promptly seek medical attention in the case that they arise.
  • Discuss with your doctor or pharmacist possible drug interactions between over-the-counter medications and any drugs you are taking to manage thrombocytosis (especially NSAIDs, pain relievers other than acetaminophen, and cold/flu remedies).

Conventional Treatments for Thrombocythemia

  • Aspirin to reduce risk tendency for platelets to clot (talk to your doctor)
  • Hydroxyurea - most common drug given to suppress production of plates by bone marrow (requires close medical supervision)
  • Anagrelide - more side effects than hydroxyurea, but may be considered if hydroxyurea is not tolerated [NIH].
  • Interferon-alpha - more side effects than hydroxyurea, but may be considered if hydroxyurea is not tolerated [NIH].
  • Plateletpheresis - a procedure similar to kidney dialysis, in which blood is removed via IV needle, the platelets removed by a machine, and then the blood returned via IV needle. This is usually only during emergencies [NIH].
  • Discuss with your doctor or pharmacist possible drug interactions between over-the-counter medications and any drugs you are taking to manage thrombocythemia (especially NSAIDs, pain relievers other than acetaminophen, and cold/flu remedies).

Naturopathic, Complimentary and Alternative Treatments for Thrombocytosis

Nutrition

There are a number of herbs and other natural substances that reduce the risk of blood-clot formation, but limited research on the utility and dosing of these products for treating thrombocythemia. Many of these substances may be suspected of being effective, based on the fact that surgeons tell patients not to take these substances prior to surgery, due to increased risk of bleeding during/after surgery.

Use these products only under medical supervision of both allopathic and naturopathic licensed medical providers.

Nutrition (e.g. B vitamins) may also be helpful in managing some of the side effects of the allopathic drugs. Again, use these products only under medical supervision of both allopathic and naturopathic licensed medical providers.

There is an old engineering maxim, which says, "You cannot control that which you do not measure." In all cases, monitor the results of treatment using lab tests.


Prevention of Thrombocythemia and Thrombocytosis

There is no known prevention for thrombocythemia, but risk of adverse events may be reduced by addressing other risk factors, such as high blood pressure, smoking, and possibly high cholesterol [NIH]. Dr. Weyrich also suggests that minimizing risks associated with secondary causes may reduce the risk of adverse events.

Risk of thrombocytosis may be addressed by avoiding secondary causes.


Sequelae of Thrombocythemia and Thrombocytosis

  • Clotting can occur in any part of the body, but most often affects the brain (TIA, headache, dizziness, stroke) or hands and feet (numbness, tingling). Other parts of the body may also be affected, including the heart (angina, heart attack) and intestines (abdominal pain).
  • Miscarriage (clotting in placenta).
  • Leukemia (rare).

References for Thrombocythemia and Thrombocytosis