Blood Clotting Disorder Bleeding Treatment Corticosteroids

Corticosteroids and immune globulin are among a family of synthesized or donor-collected substances used in the treatment of many illnesses. Both substances act on the body’s immune system and play a role in the production of blood platelets, specialized blood cells that are essential to clotting and the prevention of excessive bleeding. Platelets are also referred to as thrombocytes.

Corticosteroids are hormones that suppress the immune system, minimizing inflammation and swelling. Alternately, immune globulin is a type of protein that stimulates the immune system, triggering the production of healthy antibodies and blood platelets.

While corticosteroids are essential to preventing unhealthy immune system cells from attacking healthy cells in the body, these hormones work best when paired with immune globulin that can supplement this suppression with the production of healthy immune system cells to target and eliminate harmful cells. Both corticosteroids and immune globulin replacement therapies are among several options for treating thrombocytopenia.

What is Thrombocytopenia?

Thrombocytopenia is an autoimmune disorder marked by extremely low levels of thrombocytes, or platelets, in the blood. This platelet deficiency can be caused by any (or a combination) of the following:

  • a slower rate of platelet production
  • an outright attack (by the immune system) of the blood platelets
  • platelet entrapment in the spleen.

Thrombocytopenia Causes

A variety of factors can cause thrombocytopenia, including:

  • alcohol abuse
  • blood transfusions
  • bone marrow abnormalities
  • chemotherapy
  • enlarged spleen
  • inherited diseases (i.e., Congential Amegakaryocytic Thromboytopenia, Grey Platelet syndrome, etc.)
  • kidney failure
  • medications (i.e., sulfonamide antibiotics, heparin, etc.)
  • other blood disorders (i.e. aplastic anemia, etc.)
  • viral infections.

In some cases, doctors are unable to identify the cause of thrombocytopenia. Even so, treatment with corticosteroids and immune globulin can still effectively restore platelet counts.

Thrombocytopenia Symptoms

Most patients suffering from thrombocytopenia experience mild to moderate incidences of any combination of the following:

  • a higher disposition to bruising
  • frequent bleeding in the mouth
  • frequent nosebleeds
  • heavier menstrual periods
  • rashes that appear as clusters of red “points” on the skin
  • uncontrolled or unexplained bleeding.

While the exact type and intensity of symptoms will vary depending on the gravity of the patient’s case, occasionally those with very mild cases of thrombocytopenia will experience no symptoms.

Because symptoms are so varied and general, thrombocytopenia is generally detected through blood tests taken during routine physical exams.

Thrombocytopenia Treatment: Corticosteroids

Corticosteroids suppress immune system responses to ensure platelet survival. When treating a thrombocytopenia patient with a corticosteroid, a patient’s platelet count should rise to a normal range, between 150,000 and 450,000 per cubic milliliter. As soon as platelet levels increase enough to fall within this safe zone, doctors stop administering the corticosteroid to the patient. Because some patients will relapse, additional courses of corticosteroids may be needed.

One of the first lines of corticosteroids used to treat thrombocytopenia comes from the prednisone family of drugs, which includes:

  • cortisone
  • hydrocortisone
  • triamcinolone.

Corticosteroids are available in many forms and at varying strengths. Regardless of the dosage your doctor administers, keep in mind that you will need to “wean” yourself off of these types of drugs over several days or weeks, depending on the amount and type of corticosteroids your doctor prescribes. Slowly reducing your dosage over time gives your adrenal glands time to reestablish their production of natural steroids.

Side Effects of Corticosteroids

Longer-term use of corticosteroids can create a host of side effects, some of which are very serious. Inpiduals may experience any of the following:

  • cataracts
  • facial hair growth
  • increased blood sugar
  • immune deficiency
  • localized fat deposits
  • mood swings
  • muscle weakness
  • obesity
  • osteoporosis.

Although many of these potential side effects are temporary conditions, some (such as osteoporosis) may lie latent for several years after treatment ceases. As a result, testing for side effects should be ongoing, continuing far after the initial corticosteroid treatment.

Thrombocytopenia Treatments: Immune Globulin Replacement

Also known as gamma globulin or IgG, immune globulin is a concentrated solution of healthy antibodies that assist the body’s own immune system by targeting the incorrectly wired antibodies that attack healthy platelets. To make immune globulin, scientists use machines that separate whole blood from the globulin in it. After undergoing decontamination, this pure globulin is combined with the decontaminated globulin extracted from the blood of many other donors.

Immune globulin replacement can create a rapid rise in platelet counts, preventing excessive bleeding during surgery or emergency treatment for trauma. Doctors typically administer immune globulin in one of the following ways:

  • directly to the veins (intravenously)
  • into the muscle tissue (intramuscularly)
  • under the skin (subcutaneously).

Keep in mind, however, that, although the administration of immune globulin produces immediate results, it is only effective for a short while.

Risks of Immune Globulin

Delivering fresh antibodies, such as immune globulin, to the bloodstream can cause mild to severe allergic reactions in some patients. Other side effects associated with immune globulin may include:

  • chest pain
  • chills
  • excess clotting (Because immune globulin protects platelets, it can cause the blood to clot too much. However, adjusting the rate of transfusion through the intravenous flow rate can generally prevent or minimize this side effect.)
  • fever
  • headache
  • leg pain
  • low blood pressure (hypotension)
  • nausea.

Severe reactions, including kidney failure, are rare.

While immune globulin replacement therapy is an effective treatment for thrombocytopenia, the following patients aren’t suitable candidates for this treatment option:

  • patients with a history of stroke, heart attack or any condition in which blood clots have created blockage that has led to serious health conditions
  • patients with an IgA deficiency (IgA is a second group of antibodies found in the human body, including the respiratory tract and tear/sweat secretions.)
  • patients with known kidney conditions
  • pregnant women (Researchers are still investigating the effects immune globulin on a fetus.).

As with many other medications and treatments, the benefits of corticosteroids and immune globulin can outweigh the risks of developing known side effects.

Resources

Harrison, Clair, Dr. and Machin, Samuel (2006). Thrombocytopenia (Reduced Platelet Count). Retrieved September 22, 2007, from the Netdoctor.co.uk Web site: http://www.netdoctor.co.uk/diseases/facts/thrombocytopenia.htm.

Mayo Foundation for Medical Education and Research (2006). Prednisone and other corticosteroids: Balance the risks and benefits. Retrieved September 22, 2007, from the MayoClinic.org Web site: http://www.mayoclinic.com/health/steroids/HQ01431.

Mayo Foundation for Medical Education and Research (2006). Treatment of Thrombocytopenia in Children at Mayo Clinic. Retrieved September 22, 2007, from the MayoClinic.org Web site: http://www.mayoclinic.org/pediatric-thrombocytopenia/.