Management of Adult Idiopathic Thrombocytopenic Purpura

Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Annual Review of Medicine (Impact Factor: 12.93). 02/2005; 56(1):425-42. DOI: 10.1146/
Source: PubMed


Idiopathic thrombocytopenic purpura (ITP) is a common hematologic disorder manifested by immune-mediated thrombocytopenia. The diagnosis remains one of exclusion, after other thrombocytopenic disorders are ruled out based on history, physical examination, and laboratory evaluation. The goal of treatment is to raise the platelet count into a hemostatically safe range. The disorder is usually chronic, although there is considerable variation in the clinical course and most patients eventually attain safe platelet counts off treatment. However, a subset of patients has severe disease refractory to all treatment modalities, which is associated with considerable morbidity and mortality. This article focuses on the management of primary ITP in adults. We discuss criteria for treatment, the roles of splenectomy and other treatment options along with their side effects, and the management of ITP during pregnancy.

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    • "Treatment in patients with ITP is dynamic and may alter in various situations. Patients with life threatening bleeding may need treatment with glucocorticoids, IVIG, platelet transfusion, plasmapheresis or even emergency splenectomy as initial treatment ( [5,6]). Initial response to conventional prednisolone therapy (1-2 mg/kg/day) varies from 65% to 85%, but sustained response has been reported to be less than 25% ( [7]). "
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    ABSTRACT: Introduction Immune thrombocytopenia (ITP) is an immune disorder commonly presents as isolated thrombocytopenia. Generally corticosteroids are the main treatment of ITP. This study was designed to evaluate effectiveness of high dose dexamethasone comparing conventional corticosteroid therapy in the treatment of ITP. Materials and methods In a randomized prospective study, sixty adult patients with newly diagnosed primary symptomatic ITP (Platelet count < 20,000) were evaluated. Patients divided into two groups. In group A, thirty patients (mean age of 24.9 years) received Dexamethasone 40 mg/IV/daily for four days (10 mg/q6h); and then Prednisolone 1 mg/kg/day/PO with rapid tapering of prednisolone (10 mg/week). From the other hand, in group B, thirty patients (mean age of 27.2 years) were treated with Prednisolone 1 mg/kg/day/PO for four weeks, then the drug tapered weekly. Results All the patients in group A showed favorable response within the first seven days, 27 cases presented complete response (CR) and three cases revealed response (R). In group B, 11 cases had CR, 13 cases showed R and six cases had No response (NR). After three months, rates of CR were 80% and 23.3% in group A and B; respectively. Responses were 16.7% and 33.3%, NRs were 6.6% and 43.3% in group A and B; respectively (P < 0.0001). After 6 months, CR was 73.3% vs.16.7%, and R was 16.7% vs.36.7% and NR was 10% vs. 46.7% in group A and B; respectively (P < 0.0001). After 12 months, there was no change in response rate in group A, but in group B 53% were non responsive, 40% showed R (chronic ITP) and complete response was observed only in 6.7% (P < 0.0001). Three cases in group A and 12 cases in group B had needed splenectomy (P < 0.00002). Conclusion We showed that high dose dexamethasone is more effective than conventional steroid therapy in newly diagnosed ITP as initial treatment with less relapses and toxicities.
    Full-text · Article · Aug 2012 · DARU-JOURNAL OF FACULTY OF PHARMACY
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    • "The established treatment practices for chronic ITP have also undergone a major change. After a long period of standard treatment approach using steroids, splenectomy, and immunosuppressive therapy, a breakthrough came with the use of B-cell depletion therapy (Cines and McMillan, 2005). The availability of monoclonal antibody, rituximab, has led hematologists to reconsider the role of splenectomy in the frontline management of chronic ITP (Arnold et al., 2007). "

    Full-text · Chapter · Nov 2011
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    • "Because severe bleeding is rare in patients with ITP and normally occurs when platelet counts are <10,000/μL,17 the main goal of therapy is to maintain a safe platelet count (not necessarily a normal count) to prevent major bleeding, while withholding drugs, when possible, to avoid adverse effects of therapy that often exceed any problems caused by the ITP.1 Keeping these criteria in mind, patients with mild, asymptomatic thrombocytopenia should not be treated unless they have a risky lifestyle (sports etc)18 or they are at risk for bleeding because of associated conditions ( hypertension, cerebrovascular disease),15,19 have disorders requiring treatment with anticoagulant or antiplatelet agents, or a need for surgery or other invasive procedures. If patients have moderate or severe thrombocytopenia and bleeding symptoms, treatment must be started but should be limited in duration unless symptomatic thrombocytopenia persists. "
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    ABSTRACT: Chronic immune thrombocytopenic purpura (ITP) is generally a more benign disease than previously thought. Currently it is recommended that only those patients with severe and/or symptomatic thrombocytopenia definitely require treatment. Additional factors, such as age, lifestyle, and uremia can also influence the hemorrhagic risk and should be carefully assessed before decision-making on the appropriate management of patients with less severe forms of ITP. The recent introduction of new classes of therapeutic agents such as rituximab and the thrombopoietic growth factors has had a major impact on the management of ITP. Updated treatment guidelines have recently been made available but they are based largely on expert opinion rather than on high-quality clinical trial evidence. This structured review is focused on the management of adults with chronic ITP, including the use of new classes of agents.
    Full-text · Article · Oct 2010 · International Journal of General Medicine
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