I was away from my computer and have just now seen your additional question.
I know this is a very difficult situation for both you and Spinach.
You may already know this but Thrombocytopenia is usually seen secondary to:
1. Increased destruction as might be seen in Rickettesial or tick diseases or auto-immune diseases such as Immune Mediated Thrombocytopenia
2. Decreased production in the bone marrow. Some sort of underlying cancerous problem might be suspected to cause this problem. It would take a bone marrow biopsy to detect such an issue.
3. Sequestration such as in the spleen. Unfortunately, this is usually associated with a cancerous process, too, such as lymphoma. An ultrasound with a needle aspirate can be helpful in making this diagnosis.
4. Rodenticide poisoning.
5. Cancer elsewhere in the boy
6. Certain drugs have triggered Immune mediated disease such as Cephalexin or some non-steroidal anti-inflammatory drugs (Carprofen).
It can sometimes be challenging to identify the cause of the low platelet count.
You don't mention if a specific diagnosis has been made or what additional testing has been done; therefore, I can only provide generalities as to treatment options that might be open to you.
1. As I mentioned above, when the platelet count is this low and there is obvious hemorrhage, then a transfusion is almost mandatory.
2. Supportive care such as anti-vomiting drugs and fluids are important.
Over the counter drugs such as Pepcid AC or Famotidine) can be given in an attempt to control nausea but since they are oral, they may not be as effective as injectable drugs would be. Famotidine is also available in an injectable form. The dose would be 1/4th mg/lb twice a day.
Other options include Ranitidine at a dose of 1 mg/lb twice a day or Omeprazole at a dose of 1 mg/lb once a day.
I don't know what drugs you have in India but if you provide me with what you have available, I can provide a dose.
Cerenia is a veterinary drug which is a very potent anti-vomiting drug but, again, I don't know if this is available to your vets. It does come in an injectable form and thus would be preferred to oral pills.
3. If a rodenticide (rat poison) is suspected, then Vitamin K should be given. In symptomatic patients (as might be the case here), a loading dose of 2.5–5 mg/kg is suggested. Then 1.25–2.5 mg/kg twice daily with a fatty meal (if the patient is eating and not vomiting). For a second-generation anticoagulant or if the anticoagulant is unknown, treatment should be instituted for at least 30 days.
This drug does come in an injectable form as well as oral tablets.
4. The human supplement, Melantonin, has been shown to increase platelet numbers. The dose would be <20 kg, 3 mg twice a day; if >20 kg, 6 mg twice a day. Nature's Bounty is a good manufacturer since quality control issues are a concern when it comes to supplements.
5. Avoid drugs that decrease platelet function. While meloxicam has minimal effect on platelet aggregation, carprofen should be avoided. Penicillins and Cephalexin may aggravate clinical hemorrhage in thrombocytopenic patients and should be avoided.
6. If Auto-immune Thrombocytopenia is suspected and steroids are not effective after 7-14 days, then other immunosuppressive drugs should be considered:
a) Azathioprine (Imuran®): 2 mg/kg q 24 h. A complete blood count (CBC) should be monitored for possible changes to all cell lines and monitor liver values for hepatotoxicity. Combination therapy with prednisone and azathioprine has been reported to have longest survival times.
b) Cyclosporine (Neoral®): 5-10 mg/kg/day divided twice daily. Neoral® is preferred over Sandimmune® (10mg/kg every12-24 h) because of more consistent absorption. However it has used on a limited basis because it is costly and requires therapeutic drug monitoring within the first 24-48 hrs then every few weeks are.
c) Leflunomide: 4mg/kg every 24h. Leflunomide has been reported in a few studies to be effective in treating immune-mediated and inflammatory diseases.
7. I would feed moist, gruel-type food to avoid trauma to the esophagus.
8. Avoid handling as much as possible and provide well padded areas for sleeping.