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Standard Treatment of Adult Chronic ITP

**Please Note: It should be understood that treatment philosophies differ among physicians and that there are many correct approaches to therapy. The approach described here reflects the biases of the author. The drug doses that are described in some of the sections represent those commonly prescribed. Drug doses, in individual patients, may differ from those listed here and depend on the patient's clinical situation and the doctor's preferences. Decisions on the treatment of individual patients with ITP are the sole responsibility of the treating physician.

Who should treat ITP? Initial treatment (steroids/anti-D/splenectomy) in an uncomplicated patient can be managed by a general internist with experience in this area. If the patient is actively bleeding or has failed to respond to intitial treatment with corticosteroids, anti-D or splenectomy, a hematologist/oncologist should be contacted. In extremely complicated cases, the treating hematologist/oncologist may wish to contact a consultant with a special interest in adult chronic ITP. For a list of consultants, click here.

Indications for treatment. Treatment is indicated only in patients who are unable to maintain platelet counts consistently over 25-30,000. There are occasional exceptions to this (patients should discuss this with their doctor). Patients whose lifestyle involves a significant risk of injury (e.g., a professional football player) will require higher platelet counts for safety.

General treatment recommendations. Patients with low platelet counts should: (1) avoid aspirin or non-steroidal anti-inflammatory drugs, such as ibuprofen, since these agents may interfere with platelet function and induce bleeding. For mild pain relief, acetominophen (Tylenol) is safe since it does not affect platelet function; (2) avoid situations where significant injury could occur (e.g., football, skiing, sky diving, etc.)

Index of Treatment Options

Click on the underlined headings for details about that subject.

  • Emergency treatment
  • Initial specific treatment
    • Corticosteroids
    • Anti-D Antibody
    • Splenectomy (surgical removal of the spleen)
  • Treatment of ITP patients who do not respond to corticosteroids or splenectomy
    • First Line Therapy
      • Corticosteroids
      • Rituximab (Rituxan)
      • Danazol (Danocrine)
      • Colchicine
      • Dapsone
    • Second Line Therapy
      • Cyclophosphamide (Cytoxan)
      • Azathioprine (Imuran)
      • Mycophenolate mofetil (Cellcept)
      • Cyclosporine
    • Third Line Therapy- Aggressive chemotherapy
      • High-dose cyclophosphamide
      • Combination chemotherapy
    • Fourth Line Therapy- Treatments with various limitations
      • Ascorbic acid (Vitamin C)
      • Gammaglobulin (long-term)
      • Vinblastine (long-term)


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