What are the International Consensus Report recommendations for emergency 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

Emergency treatment:

  • Combination therapy, including platelet transfusions, IV corticosteroids, and IVIG, with or without anti-D, is recommended. Administer platelet transfusions as a bolus, followed by continuous infusion in combination with IV high-dose steroids (eg, IV methylprednisone/prednisolone, 30 mg/kg per day). For ICH or other life-threatening or serious bleeding, give IVIG (0.8-1.0 g/kg per day, with or without single-dose IV anti-D (75 µg/kg). A second dose of IVIG and IV steroids may be required if a platelet response is not seen within 24 hours of the initial dose.
  • IVIG, steroids, and IV anti-D (if available) can be used to attempt to ensure the most likely and fastest platelet increase. Antifibrinolytics may be given if bleeding continues despite therapy.
  • In patients with an ICH, emergency splenectomy and/or neurosurgical control of bleeding should be considered in conjunction with emergency platelet-raising therapy, but medical treatment should never be delayed because of surgical or radiologic intervention if at all possible.
  • TPO-RAs should be considered, as they may aid the acute response in patients and prevent a decrease in platelet count if initial response to emergency therapy is lost.

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