What are the American Society of Hematology (ASH) guidelines for first-line treatment of immune thrombocytopenia (ITP) in adults?

Updated: Dec 14, 2019
  • Author: Michael A Silverman, MD, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
  • Print
Answer

In adults, treatment is recommended for a platelet count < 30×109/L. The ASH recommends that if treatment is needed, shorter courses of corticosteroids (≤6 weeks) are preferred over prolonged courses (>6 weeks including treatment and taper) as first-line treatment. The guidelines suggest either prednisone (0.5-2.0 mg/kg per day) or dexamethasone (40 mg per day for 4 days) as the type of corticosteroid for initial therapy.  [7]

In adults with ITP lasting ≥3 months who are corticosteroid-dependent or have no response to corticosteroids, the ASH guidelines suggest either splenectomy or a TPO-RA. In adults who are going to be treated with aTPO-RA, either eltrombopag or romiplostim is suggested by the ASH guidelines. ASH also suggests rituximab over splenectomy. [7]

For adults with ITP, ASH guidelines recommend treating newly diagnosed patients whose platelet count is less than 30 × 109/L. Recommendations for first-line treatment include the following [7, 5] :

  • Shorter courses of ≤ 6 weeks are preferred over prolonged courses (>6 weeks including treatment and taper) of corticosteroids
  • Either prednisone (0.5-2.0 mg/kg per day) or dexamethasone (40 mg per day for 4 days) as the type of corticosteroid for initial therapy. 
  • IVIg may be used with corticosteroids when a more rapid increase in platelet count is required
  • Either IVIg or anti-D (in appropriate patients) be used if corticosteroids are contraindicated

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