A Perspective on Living with Low Platelet Counts:
The Big Three – Lifestyle, Diet and Surveillance
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Colin Perrott, PhD DSc FTSE
Note: This is a DRAFT document in process of completion.
“Our minds and bodies are political – they frequently promise more than they deliver and are difficult to measure against precise numbers. Rather than attempting to control them, we need to determine the limit settings.”
The article contains tables and text that don’t load up usefully into a direct page, so please go to the-big-three for the pdf version. But there is some important overview information here as a top line.
The information below is drawn largely, but not exclusively, from the Platelet Disorder Support Association website. Some additions relate to personal experience over five years with thrombocytopenia (ITP). In that period, my platelet counts have risen steadily from unsafe levels (~35,000 cu/ml) to low but safe ranges (~100,000 cu/ml), now counting as a mild case of chronic ITP. At the same time, the ability of my blood to clot has been improved markedly – all this without any overt intrusion such as removing my spleen, IVIG and prednisone therapy or rituximab therapy. Very many drugs and substances are detrimental to one’s platelets – something we each need to understand. Some almost routine medications like Ibuprofen and Tylenol need to be used with caution, as we will see below. Prescribed medications for blood pressure (Accupril / quinapril) and cholesterol control (Lipitor) can reduce the platelet count significantly, yet we need to take prescriptions necessary for general management of our health. Overall the best approach in my view is continued avoidance of drugs so far as reasonable, along with careful diet control and strict lifestyle choices. The philosophy is simply that a healthy body has best chances of mounting its own defenses and making repairs that are required.
RISKS YOU MIGHT FACE
It is important to understand the risks and simple exposures presented by diminished platelet count and NOT rush into medical intrusion unless that is warranted. In my personal view, it is more important to ensure that the clotting function is unaffected than to be concerned about platelet count – provided you have a chronic case of ITP only. A useful framework is;
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SUBSTANCES THAT REDUCE PLATELET COUNTS
Common Drugs that can significantly reduce platelet counts |
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Inflammation/Pain |
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acetaminophen |
(Tylenol, Panadol, others) – considered safe by many, however, some incidences of platelet reduction were found in journal articles. |
aspirin |
(acetylsalicylic acid, ASA) relief of mild to moderate pain and inflammation. Decreases white blood cells and platelet counts. |
ibuprofen |
NSAID |
diclofenac |
analgesic NSAID, (Apo-Diclo, Arthrotec, Cataflam, Novo-difenac,Voltaren) |
meclofenamate sodium |
NSAID (Meclomen) |
morphine |
analgesic, opioids |
naproxen |
NSAID, (Naprosyn) |
piroxicam |
NSAID, analgesic, (Apo-Piroxicam, Feldene, Novopirocam, Nu-Pirox) |
sulfasalazine |
bowel anti-inflammatory (Azaline, Azulfidine, Salazopyrin) |
Drugs that can significantly reduce platelet counts |
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Anxiety/Depression |
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diazepam |
antianxiety, tranquilizer (Valium, among others) |
chlorpromazine |
antipsychotic, tranquilizer (Chlorpromanyl, Largactil, Thorazine) |
imipramine |
antidepressant (Antipress, Apo-imipramine, Impril, Janimine, Tipramine) |
thiothixene |
(Navane) |
Arthritis |
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penicillamine |
antiarthritic, heavy metal poisoning, (Cuprimine, Depen) |
Attention Deficit Disorder |
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methylphenidate hydrochloride |
(Ritalin) thrombocytopenia purpura is listed as a side-effect |
Cancer |
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levamisole |
(Ergamisol) |
interferon alpha |
(Roferon A, Intron A) |
tamoxifen |
(Nolvadex) |
Cholesterol |
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atorvastatin calcium |
(Lipitor) – binds to plasma proteins |
See: M L Gonzalez-Ponte:, ‘Atorvastatin-induced severe thrombocytopenia. (Research Letters): Oct 17, 1998 – Lancet |
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Diabetes |
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chlorpropamide |
antidiabetic, (Apo-Chlorpropamide, Chloronase, Diabinese, Glucamide) |
Fungus Infection |
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amphotericin |
(Amphocin, Fungizone) |
Gout |
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allopurinol |
(Alloprin, Lopurin, Novopurol, Purinol, Zurinol, Zyloprim) |
Hair Loss |
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minoxidil |
antihypertensive, hair growth stimulant (Minodyl, Minoximen, Rogaine) |
Heartburn |
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cimetidine |
Heartburn Tagamet, also Zantac, Pepcid |
ranitidine |
H-2 Receptor blocker (Zantac) |
Heart Conditions |
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acetazolamide |
Used for glaucoma, seizures, retention of fluid in congestive heart |
amiodarone |
(Cordarone) |
amrinone |
(Inocor) |
diltiazem |
antianginal, antihypertensive, calcium channel blocker (Apo-Diltiaz, Cardizem) |
digoxin |
digitalis preparations, congestive heart stimulant and treatment of heart rhythms. (Lanoxicaps, Lanoxin, Novodigoxin.) |
procainamide |
antiarrhythmic (Apo-Procainamide, Procamide, Procanbid, Promine, Rhythmin) |
quinidine |
antiarrhythmic (Apo-Quinidine, Cardioquin, Duraquin, Quinora) |
High Blood Pressure / water retention |
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chlorothiazide |
diuretic, antihypertensive (Aldoclor, Diachlor, Diupres, Didudrigen, Diuril, Supres) |
chlorthalidone |
antihypertensive, diuretic (Apo-Chlorthalidone, Combipres, Hygroton-Reserpine, Thalitone, Uridon) |
furosemide |
antihypertensive, diuretic (Lasix, Lo-Aqua, Luramide) |
quinapril hydrochloride |
(Accupril) |
Infections |
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ampicillin |
antibiotic used to treat infections (Amcill, Ampicin, Ampilean, Omnipen, Polycillin, Penbritin, Principen) |
cephalosporins |
anti-infectives cefaclor (Ceclor), cefadroxil (Duricef, Ultracef), cefamandole (Mandol) cefazolin (Ancef, Kefzol, Zolicef) cefixime (Suprax) cefmetazole (Zefazone), cefonicid (Monocid) cefoperazone (Cefobid) ceforanide (Percef) cefotaxime (Claforan), cefotetan (Cefotan) cefoxitin (Mefoxin) cefprozil (Cefzil) ceftazidime (Fortaz, Tazidime, Tazicef) ceftizoxime (Cefizox), ceftriaxone (Rocephin) cefuroxime (Ceftin, Kefurox, Zinacef) cephalexin (Keflex, Keftab) cephalothin (Keflin) cephapirin (Cefadyl) cephradine (Anspor, Velosef) moxalactam (Moxam) Omnicef |
nalidixic acid |
(Negram) |
penicillin |
antibiotic causes abnormal bleeding or bruising |
pentamidine isethionate |
(Pentam, NebuPent, Pentacarinate) |
rifampin |
antibiotic (Rifadin, Rifamate, Rofact) |
sulfamethoxazole |
anti-infective (Apo-Sulfatrim, Bactrim, Comoxol, Septra, etc.) |
trimethoprim/sulfamethoxazole |
anti-infective (Apo-sulfatrim, Bactrim, Coptin, Septra) |
vancomycin |
anti-infective (Vancocin, Vancoled, Vancor) |
Malaria |
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chloroquine |
used to treat malaria and amebic infection , causes bone marrow depression (Aralen, Kronofed-A-JR) |
hydroxychloroquine |
(Plaquenil) – antimalarial, immunosuppressant, used in lupus, rheumatoid arthritis, causes bone marrow suppression |
Premenstrual Distress |
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Sarafem |
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Seizure Disorders |
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acetazolamide |
anticonvulsant (Ak-Zol, Dazamide, Diamox, Storzolamide) |
carbamazepine |
anticonvulsant , reduced formation of all blood cells (Apo-carbamazepine, Epitol, Mazepine, Tegretol). |
phenytoin |
anticonvulsant (Dilantin, Ekko JR, Mebroin, Phelantin) |
topiramate |
anticonvulsant (Topamax) |
valproic acid |
anticonvulsant (Depakote, Epival) |
zonisamide |
(Zonegran) also used for migraine and weight loss |
Tuberculosis |
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isoniazid |
antituberculosis (Isotamine, Laniazid, Vitamin B-6) |
ethambutol |
(Myambutol) |
Products that Contain phenylpropanolamine (PPA) can reduce the number of Platelets |
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Acutrim Diet Gum Appetite Suppressant Plus Dietary Supplements Acutrim Maximum Strength Appetite Control Alka-Seltzer Plus Children’s Cold Medicine Effervescent Alka-Seltzer Plus Cold medicine (cherry or orange) Alka-Seltzer Plus Cold Medicine Original Alka-Seltzer Plus Cold & Cough Medicine Effervescent Alka-Seltzer Plus Cold & Flu Medicine Effervescent Alka-Seltzer Plus Cold & Sinus Effervescent Alka Seltzer Plus Night-Time Cold Medicine Effervescent BC Allergy Sinus Cold Powder BC Sinus Cold Powder Comtrex Deep Chest Cold & Congestion Relief Comtrex Flu Therapy & Fever Relief Day & Night Contac 12-Hour Cold Capsules Contac 12 Hour CapletsCoricidin D Cold, Flu & Sinus Dexatrim Caffeine Free Dexatrim Caffeine Free Dexatrim Extended Duration Dexatrim Gelcaps Dexatrim Vitamin C/Caffeine Free |
Dimetapp Cold & Allergy Chewable Tablet Dimetapp Cold & Cough Liqui-Gels Dimetapp DM Cold & Cough Elixir Dimetapp Elixir Dimetapp 4 Hour Liquid Gels Dimetapp 4 Hour Tablets Dimetapp 12 Hour Extentabs Tablets Naldecon DX Pediatric Drops Permathene Mega-16 Robitussin CF Tavist-D 12 Hour Relief of Sinus & Nasal Congestion Triaminic DM Cough Relief Triaminic Expectorant Chest & Head Congestion Triaminic Syrup Cold & Allergy Triaminic Triaminicol Cold & Cough Triaminic Orange 3D Cold & Allergy, Cherry (Pink) 3D Cold & Cough, Berry 3D Cough Relief, Yellow 3D Expectorant
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Go to the FDA website for more information: www.fda.gov/cder/drug/infopage/ppa/ |
Other substances that can reduce the number of platelets |
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alcohol |
gold and gold salts |
alfalfa sprouts ( if likely to harbor salmonella) |
Metabalife (contains Ma Huang and other substances that interfere with blood clotting) |
allicin (in Kwai, Kyolic & other garlic supplements) |
niacin (by causing liver problems) |
chlorine |
pesticides |
dong quai (angelica sinensis) |
quinine (found in tonic water and bitter lemon) |
echinacea |
salicylates |
Substances that reduce the ability of platelets to clot |
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aspirin aspartame (can also cause thrombocytopenia) beer (especially dark beer) blueberries chocolate (dark) chondroitin sulfate (can act like heparin) vitamin E feverfew heparin (can also cause thrombocytopenia) garlic/onions gingko biloba (can also reduce platelet count) ginger
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ginseng goldenseal green tea guarana red/purple grape products (grape juice, red wine, raisins) pycnogenol Omega 3 fatty acids SSRI’s (Prozac, etc.) Quercetin, rutin, and related bioflavonoids ticlopidine (ticlid) used to prevent blood clots tomatoes wood ear mushrooms |
DIET SUGGESTIONS: www.itppeople.com/survey/2001/index.html
These suggestions are guidelines only. Be sure to discuss any diet changes with your physician.
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Eat a wide variety of fresh food
Maximize the value of each bite. Eat food from as close to the source as possible and as soon as possible. Avoid canned and frozen foods and leftovers. The nutritional value of food deteriorates with time. A wide variety of food assures your body gets the variety of nutrients it needs. -
Eat whole foods
Eat whole grain cereals, brown rice, and whole wheat products. Reduce the amount of white flour, white rice and processed foods. Processed grains are stripped of their natural nutrient-rich coating. -
Eat organic foods
Eat un-sprayed foods grown using natural fertilizers. Some pesticides and herbicides have been shown to exacerbate autoimmune diseases and lower platelets. Additives and preservatives can increase the disease-causing free radicals in your body. -
Reduce sugar
Reduce the amount of white refined sugar as well as fructose, corn syrup, honey and other sweeteners. Limit fruit and fruit juice. Sugar contributes to an acidic disease-promoting body condition. -
Reduce dairy products
Reduce or eliminate milk, cheese, ice cream, and yogurt from your diet based on your reaction to these foods and other dietary needs. Dairy foods have been shown to contribute to mucus formation and exacerbate some autoimmune diseases. -
Eat healthy fats
Use cold pressed oils such as olive or canola in cooking and baking. Avoid hydrogenated, partially hydrogenated or trans-fats. These contribute to free radical damage. Reduce the amount of deep fried food which also adds to the free radical load. -
Eat green
Eat as many leafy greens as possible, especially kale and collards. Add sea vegetables (sea weed) to your diet. These choices contain large amounts of calcium, minerals, and vitamin K to help clotting. -
Limit meat
Rely on lean, white fish, whole grains and beans and some nuts for protein. Meat is often laced with residual antibiotics, hormones, and saturated fat. -
Avoid problem foods
Avoid alcoholic beverages which can damage bone marrow. Reduce the amount of blueberries, red/purple grape products, garlic, onions, ginger, ginseng, and tomatoes. These foods can interfere with blood clotting. Avoid food and drinks containing quinine[1]: -
Avoid allergic foods
Many people have delayed food allergies that produce vague and difficult-to-diagnose symptoms. If you don’t feel well, consider having a food allergy test. -
Chew your food well
Chewing each bite until it is liquid can aid digestion, aid the passage of nutrients into your blood stream, and promotes healthy alkaline blood chemistry. -
Drink pure warm water
Drink plenty of filtered or bottled water at room temperature or above. Taking periodic sips of hot water can cleanse impurities from the body. Ice water can slow and hinder the digestive process. Tap water may contain small amounts of chemicals that are harmful.
The starting point might indeed be Cordarone as you suggest. Looking up amiodarone (aka cordarone) gives the information that hematologic side effects have been reported – although rarely. Cases of bone marrow suppression resulting in normocytic, normochromic anemia or thrombocytopenia have been reported along with other side effects. Go to http://www.drugs.com/sfx/cordarone-side-effects.html and look at the whole list. The advice there is to choose a drug with reduced toxicity if possible. But all that won’t reveal what to do now. You need good medical advice. Put the relevant information forward. Best of luck, Colin