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How to Treat Immune Thrombocytopenic Purpura?


Things to note:
Avoid:
    • Medication that affects platelet function, e.g. NSAIDs and aspirin,
    • Platelet transfusion unless life-threatening bleeds,
    • Dental procedures in acute phase, and
    • IM injections.
  • Reassure the patient that resolution usually occurs in acute ITP.
  • Medic alert bracelet.
  • Platelet transfusions may be given if surgery is required or in life-threatening bleeding.

Medical Treatment:
Acute ITP
  • Prednisone, oral, 2 mg/kg daily.
    • Taper dose once response is achieved, usually within 10-14 days.
    • Therapy may be required for a few months before prednisone is eventually discontinued.
    • Also indicated for HIV-associated immune thrombocytopenia. Also start combination antiretroviral therapy urgently in these patients.
Platelet transfusions
  • Transfusions of platelets are indicated only in active bleeding uncontrolled by other means or before procedures.In an adult, 1 mega-unit of single donor, leucocyte depleted platelets are usually sufficient to initially control bleeding.In this condition, platelet transfusions have limited benefit as platelets are rapidly destroyed by the immune system.


When to refer:
  • All cases not responding to steroids and, in the case of HIV patients, not responding to ART-Discuss with haematologist.