Hematology/ITP and Bleeding
Hello, Dr. Kulharni. I kindly thank you for taking my question.
My 61 year old husband has ITP (for 13 years) probably from benzene exposure as a truck driver. (All other blood work is normal.) His platelets are usually 21k to 27k. He will not take a maintenance dose of steroids; he does not like the side effects. The only treatment he responds to is Dexamethasone & IVIG and will only take that when his platelets get into the teens.
My question is this: He has hemorrhoids. He bleeds when he has a bowel movement and sometimes hours afterwards. He will find blood in his clothes.
When he has IVIG and dexamethasone to increase his platelets, his hemorrhoids swell very large and are very painful.
He cannot have any type of surgery or procedure due to his ITP.
We have discussed a splenectomy but are afraid to take that risk since it does not always solve the problem of ITP.
We are very unsure on what to do about this problem. We do not know whether to see a GI doctor or his hematologist.
Thank you for our advice.
Warm welcome to you!
Normally splenectomy works out well in 50% of the cases. But has he tried other drugs like prednisone and danazol? Hemorrhoids is a very common issue with the truck drivers. Right now he can try stool softners and over the counter gels available. But if the issue is not resolved then should get it examined by nearest doctor. Because sometimes there can be clots formed inside the hemorrhoids. Other thing is to avoid hemorrhoids he should drink lots of water which would prevent his becoming excessive hot. Also foods which generate too much body heat should be avoided. If you have any further queries you can always ask me!