Frontline Treatment of Idiopathic Thrombocytopenic Purpura

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Clinicians may initiate treatment of idiopathic thrombocytopenic purpura (ITP) to make a diagnosis, mitigate a risk of bleeding, or treat active bleeding. The decision to begin treatment for ITP should be individualized for each patient, states Ivy Altomare, MD. According to the recent ASH Guidelines and International Consensus Report, steroids are the standard first-line treatment for ITP. Although there are currently no clinical trial data recommending an exact course of steroids, Altomare notes that many practitioners use 1 mg per kg of prednisone.

Many clinicians will treat ITP until the platelet count normalizes, then treat for another week at that same dose followed by a gradual tapering. Howard A. Liebman, MD, mentions that patients who are asymptomatic with few manifestations (fatigue, bruises, nose bleeds) may not receive any treatment, even if their platelet counts are below 30,000. Liebman explains that these individuals should be closely followed and educated regarding the manifestations associated with bleeding, as well as circumstances that may aggravate their immune thrombocytopenia, such as concomitant infection or other medications they are taking.