Asymptomatic patients do not usually require treatment. There is no evidence to support the reduction of platelet counts except where there is evidence of vaso-occlusive phenomena - for example, digital pain, transient ischaemic attacks. Aspirin in conjunction with a cytoreductive agent, such as hydroxyurea are then given (1).
Patients who wish an urgent reduction of the platelet counts can be treated with plasmapheresis. However, rebound thrombocytosis may occur once therapy is complete.
Patients who are asymptomatic and have no indications for cytoreductive therapy should continue observation or antiplatelet therapy (e.g., aspirin), as clinically indicated.
Patients who are symptomatic and have indications for cytoreductive therapy should be treated with a cytoreductive agent (in addition to antiplatelet therapy).
Bone marrow aspirate and biopsy should be performed to rule out disease progression to myelofibrosis prior to the initiation of cytoreductive therapy.
Hydroxycarbamide is the preferred cytoreductive agent in most patients.
Anagrelide reduces platelet counts without increasing the risk of bleeding and is currently being investigated.
Reference:
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