Suggest treatment for fluctuating platelets counts
Patient: Hi, I am an ITP Patient. I am 27 years old. First diagnosed in 2002 when my platlets count was 40,000. That time Bone marrow test result was Pheripheral destruction. after this upto Jan, 2011 i was completely normal even i never felt that i have any problem. But my platlets count once again fall to 5,000 only when i shifted to a place very far from my home where the air and water(chlorinated water) was very poluted. my treatment was done with blood transfussion + Deltacortil tablets. Then my platlets count was normal for a few months but then fall down even taking the deltacortil tablets... then the doctor suggested to discontinue  medicine. After this my platlets were falling down but when it reached to 30,000 it then start increasing. After remaining normal for 3 months now again falling...  I want to ask..  1. what treatment U suggest...  2. Changing living place is a factor or not...  3. Removing Spleen is a solution or not... Doctor: Thanks for contacting HCM. Dear patient there are many approaches to treatment and following treatments can be tried :-1 Steroids, like your doctor gave you delacortil.2. Human anti D immunoglobulin helps in some cases.3.Immunosuppresants like azathioprine or mycofenolate mofitil.4.intravenous immunoglobin (IvIg).5. Thrombopoitin recptor agonists like romiplostim and eltrombopag.6. H.pylori eradication in some cases has helped.7. Platelet transfusion should be used only in dire emergency as it has short lasting effect causes autoimmune destruction donor's pletelets.Splenectomy can help as cause long term remission in 60-65% case but there is a definite risk of bleeding during surgery.Changing place will hardly have any effect.regards