What are the International Consensus Report recommendations for initial treatment of children with immune thrombocytopenia (ITP)?

Updated: Jan 11, 2020
  • Author: Craig M Kessler, MD, MACP; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

Initial treatment regimens:

  • If the patient has moderate or severe bleeding, IVIG and anti-D can often increase the platelet count to hemostatic levels (>50 × 10 9/L) within 24 to 48 hours. IVIGg is effective when given as a single dose of 0.8 to 1.0 g/kg. Anti-D has similar efficacy to IVIG when given as a single dose of 75 µg/kg and is rarely associated with severe hemolysis. High-dose steroid premedication is recommended for IV anti-D and is useful for IVIG.
  • A second dose of IVIg or anti-D may be administered if there is a suboptimal initial response and/or ongoing bleeding.
  • Give prednisone/prednisolone at 4 mg/kg per day in 3 or 4 divided doses for 4 days with no taper, with a maximum daily dose of 200 mg or at 1 to 2 mg/kg, with an 80-mg maximum daily dose, even in patients weighing >80 kg, for 1 to 2 weeks. If a response is seen (eg, platelets > 50 × 10 9/L), taper the prednisone/prednisolone, aiming to stop it by 3 weeks, even if the platelet count drops during the taper.
  • If there is no response to the initial dose within 2 weeks, taper the prednisone/prednisolone rapidly over 1 week and stop it.
  • In general, corticosteroids are used for grade 1 or 2 bleeding or for patients not responsive to IVIG.
  • IV anti-D can be used if the patient is Rh positive, not splenectomized, does not have a positive direct Coombs test (DAT), and has hemoglobin ≥9 g/dL.

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