Platelets are very sensitive and can react to many substances, interfering with their ability to clot or triggering their removal from circulation. Be sure to tell your doctor if your platelets drop or extra bleeding coincided with any new food, drugs, herbs, supplements, or environmental exposure. “Several hundred drugs, toxins and herbs have been reported to cause blood abnormalities, and drugs account for 20-40% of all instances of cytopenias”.1
This page contains some of the most well-known causes of substance-induced thrombocytopenia and associated bleeding. If you suspect that something you are taking, eating, or breathing might be the cause of your low platelets or excessive bleeding and you don’t see the link on this page, try searching the Internet using the terms “substance platelets" or "substance thrombocytopenia" where substance is the suspected item. While there is no guarantee, it is possible that removing or discontinuing the offending substance can have a positive effect on your platelet count. It is important to communicate with your doctor/healthcare provider as you consider or make changes.
When drugs are the cause of low platelets, the disease is called drug-induced thrombocytopenia (DITP). In some cases, as in chemotherapy drugs, the drop in platelet count is due to changes in the bone marrow. In other cases antibodies can develop to both the drug and platelets at the same time, causing the platelets to drop. Sometimes drugs cause a combination of both bone marrow and immune problems.42
DITP is rare, can occur with any medication, and is no more likely in patients with ITP than in others, as far as we know. However, sometimes patients are misdiagnosed with ITP when a substance they ingested caused their low platelets. We have also heard from patients who have been diagnosed with ITP and a new drug prompted their platelets to drop further.
In the case of DITP caused by an immune reaction, platelets usually drop within one to two weeks after taking the problem drug. However, low platelets can occur almost immediately after taking some drugs that interfere with the production of blood clots. If the drug responsible for low platelets is stopped, platelets may begin to recover in one or two days, but the antibodies to the drug can linger in the blood stream for a very long time and cause future problems.2,42 Often the reaction to the drug is specific and a similar compound can be substituted without ill effect.42 If the suspected drug is stopped and the platelets recover, other drugs are introduced without a problem, other causes of thrombocytopenia are excluded, and the drug is introduced again and the platelets drop, there is a definitive diagnosis of DITP. If only the first criteria is met, DITP is a possible cause of thrombocytopenia. If all but the last criteria are met, DITP is the probable cause.2
Some drugs have been reported to cause more instances of DITP than others. Sulfa drugs, vancomycin, penicillin, rifampin, ceftriaxone, trimethoprim/sulfamethoxazole and linezolid (antibiotics), gold salts, valproate (for epilepsy), amrinone (for heart problems), biophosphates (ex. Fosamax), quinidine (for abnormal heart rhythms), carbamazepine (controls seizures), mirtazapine (anti-depressant), oxaliplatin and suramin (chemotherapies), the glycoprotein IIbIIIa inhibitors abciximab, tirofiban and eptifibatide, heparin (anti-clotting agents) and quinine (see below) are particular problems. Be sure to tell your doctor if you are taking any herbal remedies or common non-prescription drugs such as acetaminophen (ex. Tylenol) or ibuprofen (ex: Advil, Motrin) as these can also cause DITP.42,45 There should be a compelling reason for taking any medication and medical attention is needed for any side effect, including bruising/bleeding.
Dr. James George and colleagues at the University of Oklahoma track published reports of drugs that cause low platelets and update a summary list every two years.2 Unfortunately, many instances of DITP are not published, so there is no comprehensive compilation of problem drugs. Visit Dr. George's web site to view his list.
The Blood Center of Southeastern Wisconsin has a test for drug-associated antibodies that can help confirm a diagnosis of DITP.
Quinine: A special case
Quinine is found in some drugs as well as in tonic water, bitter lemon, and bitter melons. Some people whose low platelets were due to drinking or eating these things have been misdiagnosed as having ITP.
In a study of 343 patients, 28 (8%) were found to have drug-induced thrombocytopenia and 13 of these cases were caused by quinine. Three of these people had an unnecessary splenectomy.2
Herbs, Food, and Supplements
Some food, herbs, and supplements can reduce the number of platelets for various reasons. This list includes those substances that have been documented in journal or other articles. It is not known whether there are few items in this category or if they are underreported. If your platelets drop after taking something new, please notify your doctor.
- Alcohol3,44 (also called ethanol-induced thrombocytopenia)
- Aspartame (NutraSweet)5
- Cow’s milk*6
- Cranberry Juice*6
- Erucic acid (in Lorenzo's oil, some rapeseed and mustard oil)46
- Jui [a Chinese medicinal herbal tea]*7
- Lupinus termis bean (cultivated in Egypt, a food protein supplement that contains quinolizidine alkaloids)6
- Niacin (liver damage due to long exposure)9
- Tahini (pulped sesame seeds)*6
*Allergic or cross-reaction to platelets in those with sensitivities to that substance, similar to drug-induced thrombocytopenia
Exposure to toxins and household chemicals can cause a drop in platelets in some people. Below is a list of toxins that have been documented to cause low platelets. You can find more information about environmental medicine and minimizing toxic exposure on Dr. Lisa Nagy's website. Check the NIH Toxmap for toxic locations near you or local environmental sites such as the Environmental Health Watch.
- Toluene methylbenzene (Anisen or Toluol) Smells like paint thinner, used in the many industrial processes including the production of gasoline and Coca-cola.11
- Wood preservatives and solvents12
Insecticides, chlorinated hydrocarbons, and organic phosphorus compounds41
Mycotoxins (toxins that can be produced by molds, yeast, and mushrooms)
- Mold (can be in the air, on food, or in cardboard)13
- P. sorghina (mold on grains)14
- Trichothecenes (a family of micotoxins)15
Various pesticides increase oxidative stress (implicated in ITP) and can promote platelet destruction in the spleen according to experiments in fish.43
Research and Contacts
Physicians specializing in enviromental medicine may be able to help. You can find them through the American Academy of Environmental Medicine. The impact of the environment on autoimmune disease is getting more attention at the National Institute of Environmental Health Science and the press. Many environmental medicine practitioners recommend using products that are environmental friendly and non-toxic.
(PDSA thanks Dr. Lisa Nagy for help with the environmental hazard list.)
Food and Supplements that Interfere with Platelet Function
This list contains food and supplements that can change the way platelets work and make it more difficult for your blood to clot. They do not reduce the platelet count unless noted. A small quantity of these substances will probably be safe and not cause a problem.
There are many drugs such as Plavix and Coumadin that are designed to interfere with platelet function as well as other drugs such as aspirin that reduce platelet function as a side effect of their other uses. The food and supplements listed can amplify the effect of these medications. See the results of the NIH Conference on Dietary Supplements, Coagulation, and Antithrombotic Therapies held January 13-14, 2005, for more information and an extensive bibliography.
Many of the listed substances are also antioxidants or have other properties that promote healing. A balance is important. We are publishing this list so you are aware that everyday or easily-available substances can have an effect on platelets, although their anti-clotting action is much weaker than pharmaceuticals.
If you have a reasonably high platelet count and few bleeding symptoms, many items on this list will not cause problems unless you ingest large quantities. Ironically, some patients with ITP have a clotting problem and are also taking blood thinners. Others may have a clotting problem and not know it. The propensity to clot and medication status are important factors when considering diet choices. Please discuss any concerns with your doctor.
- Alcohol (can also reduce the number of platelets)44
- Aspartame (NutraSweet, can also reduce the number of platelets)16
- Beer (including non-alcoholic beer)17,18
- Chocolate (dark)20
- Gingko biloba25
- Green tea28
- Guarana (a dietary supplement)29
- Kiwi fruit30
- Omega 3 fatty acids (hemp seed, fish oil)31, 32
- Pycnogenol (pine bark extract)33
- Quercetin, rutin, and related bioflavonoids34, 35
- Red/purple grape products (grape juice, red wine, raisins, grape seeds)36
- Red wine37
- Vitamin E39
- Wood ear or cloud ear mushroom (Auricularia auricula-judae, used in Chinese cuisine)40
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