Immune Thrombocytopenia (ITP)

Diagnosis

Diagnosis of immune thrombocytopenia focuses on ruling out other causes of bleeding and low platelet levels. There is no single test that confirms the condition. Blood tests are the first step and help measure platelet counts. In rare cases, adults may need a bone marrow biopsy to rule out other underlying problems.

Treatment

Treatment for immune thrombocytopenia depends on the severity of symptoms and platelet levels.
Some people with mild ITP need only regular monitoring. Children often recover without treatment. Most adults, however, require treatment at some point because the condition can become chronic.

Treatment options may include medicines to raise platelet counts or surgery to remove the spleen. A healthcare provider helps weigh the benefits and risks, as some treatments can have side effects that feel worse than the condition itself.

Medications

Before starting treatment, your healthcare provider may ask you to stop medicines or supplements that increase bleeding risk, such as aspirin, ibuprofen or ginkgo biloba.

Medicines used to treat ITP include:

• Steroids
  Oral corticosteroids such as prednisone are often the first treatment. Once platelet levels improve, the dose is gradually reduced. Long-term steroid use can increase the risk of infections, high blood sugar and osteoporosis.

• Immune globulin
  Used when corticosteroids do not work or when a rapid increase in platelet count is needed. The effect is usually temporary and lasts a few weeks.

• Drugs that increase platelets
  Medicines such as romiplostim, eltrombopag and avatrombopag help the bone marrow produce more platelets. These may increase the risk of blood clots.

• Other medicines
  Rituximab helps raise platelet levels by reducing the immune system’s response. However, it can make vaccines less effective. The need for future spleen removal may increase the importance of vaccines.
  Fostamatinib is a newer option for people with long-lasting ITP who have not responded to other treatments.

Surgery

If medicines do not improve platelet levels, surgery to remove the spleen may be considered. When successful, it can rapidly stop the destruction of platelets.
However, not everyone responds to this surgery, and living without a spleen increases the risk of infections.

Emergency treatment

Severe bleeding from ITP is rare but requires immediate care. Emergency treatment may involve platelet transfusions along with steroids or immune globulin delivered through a vein to quickly raise platelet counts.