What are the ASH guidelines on the 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...
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The 2019 ASH guidelines recommend against treatment of patients with a platelet count ≥30 × 109/L. For newly diagnosed patients with a platelet count < 30 × 109/L, guidelines suggest treatment with corticosterioids. For patients with a platelet count < 20 × 109/L, the guidelines suggest hospital admission for treatment. For first-line treatment, the guidelines further recommend a short course (≤6 weeks) of steroids over a prolonged course (> 6 weeks including treatment and taper) of steroids. [7]

Additional first-line treatment suggestions include the following [7] :

  • Either prednisone (0.5-2.0 mg/kg per day) or dexamethasone (40 mg/day for 4 days) as the corticosteroid 
  • Corticosteroids alone rather than rituximab and corticosteroids

The following 2011 ASH guidelines treatment suggestions remain unchanged [5] :

  • IVIG may be used with corticosteroids when a more rapid increase in platelet count is required
  • Either IVIG or anti-D (in appropriate patients) may be used if corticosteroids are contraindicated

If used, IVIG should be administered in a single dose of 1 g/kg; the dose may be repeated if necessary

Second-line treatment suggestions include the following [7] :

  • Either splenectomy or a TPO-RA.
  • In adults who are going to be treated with aTPO-RA, either eltrombopag or romiplostim
  • Rituximab over splenectomy

The 2011 ASH recommendation that for medically suitable patients laparoscopic and open splenectomy offer similar efficacy also remains unchanged. [5]

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