What are the treatment options for immune thrombocytopenic purpura (ITP)?

Updated: Apr 22, 2018
  • Author: Craig M Kessler, MD, MACP; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

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


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