Approach to increasing the platelet count in ITP

These platelet count thresholds are intended as a guide; some individuals with a platelet count <20,000 to 30,000/microL may reasonably choose not to receive treatment, and some individuals with additional bleeding risk factors may choose to receive treatment at higher platelet counts (up to 50,000/microL). We generally prefer glucocorticoids for initial therapy; we reserve IVIG (or anti-D) for those who have a contraindication to or intolerance of glucocorticoids or who require a more rapid increase in platelet count. Refer to a separate UpToDate algorithm for treatment of bleeding. Refer to UpToDate for management of comorbidities, the importance of addressing other bleeding risk factors, decision-making between different therapies, and dosing and administration of specific medications.

ITP: immune thrombocytopenia; IVIG: intravenous immune globulin; TPO-RA: thrombopoietin receptor agonist.

* Many patients with platelet counts <20,000 to 30,000/microL do not require treatment.

¶ The interval for rechecking the platelet count is individualized based on the patient's clinical status, typically ranging from a few days to a week. Responses to glucocorticoids typically occur within a few days (range, 2 to 14 days); responses to IVIG (or anti-D) can occur within 1 to 3 days.

Δ Splenectomy is generally deferred for at least 12 months after diagnosis (if possible), in case a spontaneous remission occurs.

◊ Other treatments include danazol, other immunosuppressive agents, or combination therapy.

§ The risk of adverse drug effects must be balanced against the benefit of raising the platelet count in an asymptomatic patient (refer to UpToDate for discussion).

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Approach to increasing the platelet count in ITP