Essential Thrombocytosis: Effective Alternative Treatments

One of the myoproliferative diseases known as essential thrombocytosis (aka essential thrombocythemia, and essential thrombocythaemia) is a potentially fatal condition that involves the overproduction of blood platelets. New clinical evidence has emerged that shows an assortment of herbal medicines are effective at significantly reducing blood platelets, and with negligible toxicity.

What Is Essential Thrombocytosis?

Also known as “ET”, the condition involves the over-expression of proteins that are responsible for producing blood platelets. If left unmanaged, ET can result in acute myeloid leukemia, or myelofibrosis. Additionally, extremely elevated platelets can lead to bleeding and blood clots, both of which can become fatal. One of the primary genes/enzymes implicated in the disease is known as JAK2 (janus kinase 2). Genetic mutation expression of JAK2 is believed to make certain cell types (namely hematopoietic) more sensitive to growth factors, leading to myoproliferative conditions.

Another gene/enzyme involved in ET is STAT3, which is involved in cell survival signaling, as well as inflammatory and anti-inflammatory mechanisms.

The conventional treatment for ET is aspirin, and in more severe cases a drug known as hydroxyurea, aka hydroxycarbamide. Hydroxyurea is a DNA-inhibiting medication. It has been shown to cause bone marrow toxicity, hair loss, birth defects, liver toxicity and is considered a mutagen (genotoxic) (1).

Potential Alternative Treatments for Essential Thrombocytosis

The inspiration to write this article is based on a case study, and my own clinical observations. From a Chinese herbal perspective, “blood stagnation” is referred to as “the mother of all disease”. I would translate this into biomedical terminology as strongly related to the effects of platelet aggregation and blood clotting mechanisms.

Here I present the evidence for the following 3 botanicals as potential effective treatment alternatives for Essential Thrombocytosis, aka essential thrombocythemia, and essential thrombocythaemia. The list of these 3 herbs possess documented mechanisms on various aspects of platelet metabolism. I have also used them clinically and witnessed their platelet-lowering effects:

• Salvia miltiorrhiza – an important Chinese herbal medicine with an extremely extensive array of studies documenting the plant’s therapeutic and physiological actions
• Coleus forskohlii – an Ayurvedic herbal medicine, with a moderate body of studies supporting its usage
• Paeonia lactiflora and Paeonia suffruticosa – Both forms are peony, which possess “blood moving” properties, both capable of reducing platelets and acting on platelet metabolism

Additional botanicals with documented platelet-lowering actions. I will list them, but at the time of this publication, I have not witnessed their action in lowering blood platelets:

• Scutilleria baicalensis – A Chinese “heat clearing herb”, both the baicalin and the wogonin constituents have shown potential platelet clearing actions
• Ligusticum wallichii – A Chinese herb with “blood moving” properties (4)
• Angelica genuflexa – A North American herb referred to as “angelica” (5)

***UPDATES***: A 2020 study in JAK2 knockout mice found that the supplement NAC (n-acetyl cysteine) has the ability to inhibit thrombosis caused by JAK2, and extend lifespan (R). While the effective dose in humans with ET is not known, the suggested trial dose could be between 2,400-4,800mg of NAC daily. This is based on NAC levels in other human studies for other diseases. If you attempt to use NAC for ET, please report the effects to me.

Salvia Miltiorrhiza aka Dan Shen

Salvia miltiorrhiza, aka Dan Shen has been extensively studied for its multiple physiological effects on cardiovascular function. Animal studies indicate it inhibits platelet aggregation through inhibition of calcium channel mechanisms (2, 8). Dan shen’s ability to attenuate cerebral infarction is due largely to the platelet-reducing and endothelial- supportive actions of the plant’s lipid-based Tanshinones (3). Tanshinone IIa from Dan shen has been shown to inhibit platelet aggregation in piglets through modification of eicosanoid mechanisms (9). The same study also found tanshinone IIa may work by releasing a significant number of endothelial nanoparticles.

Remarkably, salvia’s ability to protect against ischemia in rats is found to involve modification of the JAK2/STAT3 proteins (6, 7). JAK2 is centrally involved in ET. Additionally of interest is that salvia miltiorrhiza has shown effect as a Mast cell stabilizer (10, 11) . Mast cells are immune cells that release histamine. What is interesting here is that reportedly many individuals with essential thrombocytosis have histamine-related symptoms. Anti-platelet medications may also function as purinergic receptor antagonists. Purinergic receptors play an integral role in mast cell degranulation. It is known that salvia miltiorrhiza inhibits at least one of the purinergic receptors, namely P2Y12 (12).

Coleus Forskohlii

Coleus is an interesting herb, with documented abilities to modulate cyclic AMP (cAMP). cAMP is a protein derived from ATP that modulates a variety of intracellular signal transduction mechanisms, including those related to glucose and lipids, adrogenic hormones, as well as modulatory effects on adrenaline and glucagon.

Coleus has historically been used to modulate things like asthma (likely due to adrenergic effects), increasing HDL cholesterol, promotion of testosterone, improving metabolic syndrome parameters, as well as improving bone density in males.

A study done on sheep found it positively reduced platelet aggregation (13). Other studies on mice have found coleus to reduce platelet formation (14). Most significantly, a study found coleus’ ability to reduce platelet aggregation is due to its activation of platelet adenylate cyclase (15).

Interestingly, like salvia, coleus has also shown mast cell stabilizing and antihistamine effects (16).

Clinically speaking, in my case study, the use of coleus was the first herb that demonstrated a reduction in elevated blood platelets.

Paeonia Lactiflora & Suffruticosa

Both forms of peony contain a number of active constituents which possess beneficial effects on platelet aggregation and blood coagulation (17). Paeonia constituent paeonal and another paeoniflorin have been studied as anticoagulant and antiplatelet agents (18, 19).

Paeonia suffruticosa reduces COX2 and inhibits fibrosis (20). It also inhibits thromboxane A2 activation (TXA2) of platelets (20).

Clinically speaking, the addition of the suffruticosa was correlated with a reduction of blood platelet levels from my observations.

In Summary

My experience is that of the 3 primary herbs discussed, salvia miltiorrhiza is likely the most significant with respect to reduction in overall blood platelets. Even when the drug hydroxyurea was used, salvia and the other herbs discussed seemed to outperform hydroxyurea, given that her platelet levels were around 800-900 on the medication prior to starting any of the herbs discussed. The dosage used was a product containing 760 mg of salvia root and 260 mg of the salvia root extract. Each tablet is approximately 1,020mg of total herb. In an adult female, the dosage used was roughly 3,060 mgs daily.

The coleus product used contained a 30:1 extract  of the root, and 18.7 mg of the forskolin. Each tablet contains 187 mg of total herb, and 3 were taken daily.

Paeonia suffruticosa was added and seemed to correspond favorably as an assistant to the actions of the coleus and salvia.

With the addition of the 3 herbs discussed, each subsequent blood test over the course of 10 months showed a reduction of platelets. Prior to the addition of these 3 herbs, past evidence suggests platelet levels were not effectively controlled by hydroxyurea. In prior years while on the drug, the platelet levels were inconsistent and volatile, with platelet levels greater than 1,000 on many instances. With the addition of these 3 botanicals mentioned, platelets are consistently lower, and presently at or under 500. With the consistently lowered platelets, the client’s physician reduced the dosage of hydroxyurea by 50%.

Clearly there is much needed research into the use of herbal medicine for essential thrombocytosis. The documented mechanisms of action on various platelet-reducing mechanisms may serve as an important strategy for other myoproliferative disorders, and other conditions involving blood stagnation, platelet aggregation and clotting disorders.