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ITP - Chronic Immune Thrombocytopenic Purpura RX     See ITP_drug2007.pdf

Chronic ITP is the most common cause of thrombocytopenia in adults. It is due to platelet destruction by an autoantibody.

No treatment is indicated unless the platelet count is less than 25,000 to 30,000 mm3 .
Patients are treated initially with prednisone; if there is no response or relapse occurs on tapering of the prednisone, splenectomy is indicated.
Patients should be immunized with pneumococcal, meningococcal, and Haemophilus influenzae vaccines before surgery to prevent subsequent severe infections with these organisms, which occur more commonly in splenectomized patients.
Therapy with corticosteroids and splenectomy results in the cure of about 70% of patients.

The treatment of ITP that is refractory to prednisone and splenectomy is more complex. Therapy can be arbitrarily divided into four levels according to the severity of the disease, the side effects associated with the treatment, and the evidence that the treatment might work. The treatments should generally be given in the order and for the indications given here.
In the event of severe mucosal bleeding, concurrent therapy with IGIV plus platelets or high-dose methylprednisolone plus platelets may be required (see "Emergency Treatment").

Level 1 Treatments : for a platelet count less than 30,000 per mm3 .

Level 2 Treatments: only if the platelet count is less than 10,000 to 15,000 per mm3 or if mucosal bleeding is present.

Level 3 Treatments: Because of the more serious side effects, these treatments are reserved for patients whose ITP is refractory to the level 1 and 2 treatments and who have life-threatening symptoms or extremely low platelet counts (less than 5000 per mm3 ).

Level 4 Treatments: These treatments are in the "when all else fails" category, because experience with them is limited, response rates are low, or their expense and frequency of administration weigh against their use.

EMERGENCY TREATMENT: In patients with severe mucosal bleeding,
give one of the following:

  1. IVIG (IV Immune Globulin as Sandoglobulin), 1.0 gram per kg IV, followed by a platelet transfusion (a single plateletpheresis or 6 to 8 units of random platelets) or
  2. Methylprednisolone (Solu-Medrol), 1.0 gram IV daily for 3 days, and give platelets after the first dose.

Conn's Current Therapy 50th Ed. 1998
E-Medicine  ITP

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