I am 36. How do I manage ITP with diabetes and hypertension?

Question

Hello doctor,

I am a 36-year-old woman diagnosed with chronic immune thrombocytopenia (ITP) for the past five years. My platelet counts usually remain between 18,000 and 25,000/µL, and last week it dropped to 15,000/µL. I often notice petechiae, gum bleeding, and easy bruising. I have been treated with steroids several times, but I developed weight gain, high blood pressure (average 150/95 mmHg), and mood swings as side effects.

I also have type 2 diabetes, with my last HbA1c (glycated hemoglobin) at 7.6% and fasting blood sugar of 162 mg/dL. Because of repeated steroid use, my blood sugars often shoot up to 220 to 250 mg/dL. I tried Rituximab last year, but my platelets dropped again after 6 months. I also suffer from iron deficiency anemia, with hemoglobin at 9.4 g/dL and ferritin 10 ng/mL. My liver and kidney tests are normal.

Currently, my doctor is suggesting Eltrombopag, but I am concerned about side effects and whether it is safe with my diabetes and hypertension. I want to know what the best long-term treatment option is for me and if there are ways to control ITP without worsening my other conditions.

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Managing immune thrombocytopenia (ITP) on top of diabetes and hypertension is incredibly challenging, especially when the treatments for one condition exacerbate the others. You are asking exactly the right questions about finding a sustainable, long-term solution. Let’s work through this together.

First, I want to acknowledge how difficult it must be to deal with the side effects of steroids. Weight gain, hypertension, and significant blood sugar spikes are not just minor inconveniences; they have real impacts on your health and quality of life. The fact that Rituximab provided only a temporary response adds to that frustration. Your current platelet count of 15,000 μL (microliter), combined with active bleeding symptoms, means we absolutely need to find an effective treatment. The goal is to do so without worsening your diabetes and hypertension.

Eltrombopag is a type of drug called a thrombopoietin receptor agonist. It works by signaling your bone marrow to produce more platelets. The significant advantage of Eltrombopag, especially in your case, is that it is not a steroid and does not suppress the immune system like Rituximab or steroids do. Therefore, it does not directly cause weight gain, high blood pressure, or spikes in blood sugar. This makes it a much more suitable candidate for long-term management, given your diabetes and hypertension.

The main considerations with Eltrombopag are potential liver enzyme changes that need to be monitored, and a very small risk of blood clots if the platelet count rises too high. This is why close monitoring under a doctor’s care is essential. For most patients, the benefits far outweigh these risks, especially compared to the known effects of chronic steroid use.

Your hemoglobin of 9.4 g/dL (grams per deciliter) with very low ferritin indicates significant iron deficiency. This is likely due to chronic low-grade bleeding from your ITP. Treating this is a priority. We will need to start you on iron supplementation, likely oral iron, and possibly intravenous iron if oral iron is poorly tolerated, to help rebuild your red blood cell stores and improve your energy levels.

The best long-term option is one that effectively controls your ITP while minimizing the impact on your diabetes and hypertension. Based on what you’ve told me, a thrombopoietin receptor agonist (TPO-RA) like Eltrombopag appears to be a very rational and strong candidate.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.