For many people with essential thrombocythemia (ET), starting treatment helps them focus on what lies ahead and what they need to do. ET is a chronic disease: It's not curable, but it can usually be managed effectively for long periods. Careful medical supervision and therapy to prevent or treat thrombosis, a serious complication that can affect vital organs such as the brain or the heart, are important. Also, for untreated pregnant patients with ET, there's a risk to the fetus' survival.
Patients with low risk for clotting are usually observed without any therapy; low-dose aspirin can be considered. Patients with high risk for clotting require medical therapy to decrease platelets to normal levels, and are given low-dose aspirin to prevent clotting.
A risk factor for bleeding can include a very elevated platelet count (over 2 million platelets per microliter of blood). Therefore, in a young patient with low risk for clotting but with an extremely high platelet count, one should be aware of the increased risk of bleeding. In this case, use of medications to lower an extremely high platelet count should be considered, but aspirin should be avoided as it may contribute to bleeding risk (at least until the number of platelets has been decreased).
Types of ET Treatment
Your doctor may suggest that you participate in a clinical trial. Clinical trials can involve therapy with new drugs and new drug combinations.
ET therapies are aimed at:
- lowering the hematocrit and hemoglobin concentration to normal or near-normal levels
- lowering the platelet count if it's high or it becomes high over time
Sometimes a patient's platelet level may become so high it can require emergency treatment to quickly reduce it. To do so, doctors use a process called plateletpheresis. During this process, the doctor uses a special machine to skim platelets from the blood and then returns the plasma (the liquid part of blood) and red cells to the patient. It's only used in emergencies such as acute clotting complications. The platelet-reducing effect of this therapy is temporary.