How is immune thrombocytopenia (ITP) treated?

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

ITP has no cure, and relapses may occur years after seemingly successful medical or surgical management. [6] Most children with acute ITP do not require treatment, and the condition resolves spontaneously. [7, 8]

Treatment is as follows:

  • Corticosteroids remain the drugs of choice for the initial management of acute ITP

  • Oral prednisone, IV methylprednisolone, or high-dose dexamethasone may be used [9, 10, 11]

  • IV immunoglobulin (IVIG) has been the drug of second choice for many years [12, 13]

  • For Rh(D)-positive patients with intact spleens, IV Rho immunoglobulin (RhIG) offers comparable efficacy, less toxicity, greater ease of administration, and a lower cost than IVIG [14, 15]

  • RhIG can induce immune hemolysis (immune hemolytic anemia) in Rh(D)-positive persons and should not be used when the hemoglobin concentration is less than 8 g/dL

  • Sporadic cases of massive intravascular hemolysis, [16] disseminated intravascular coagulation (particularly in elderly individuals), and renal failure [17] have been reported with RhIG

  • Rituximab is third-line therapy

  • Platelet transfusions may be required to control clinically significant bleeding but are not recommended for prophylaxis

  • If 6 months of medical management fails to increase the platelet count to a safe range (about 30,000/µL), splenectomy becomes an option

  • Thrombopoietin receptor agonists (ie, eltrombopag, romiplostim) may maintain platelet counts at safe levels in adults with chronic ITP refractory to conventional medical management or splenectomy

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!