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Treatments and drugs
By Mayo Clinic staffIdiopathic thrombocytopenic purpura is usually treated by a hematologist, a doctor who specializes in blood disorders. The goal of treating ITP is to ensure a safe platelet count and prevent bleeding complications while minimizing treatment side effects.
Because of the potential complications of both the disease and its treatment, it's important for you and your doctor to carefully weigh the benefits and risks of treatment. For example, some people find that the side effects of treatment are more burdensome than the effects of the disease itself. Treatment decisions are usually based on:
- Severity of signs and symptoms (active bleeding is usually an indication for treatment)
- Platelet count — even relatively low counts (less than 30,000 units per microliter of blood) may not merit treatment, especially if you have no active bleeding and have a fairly sedentary lifestyle
- Age
- Risk of bleeding relative to lifestyle, such as participation in sports or other vigorous physical activities that may predispose you to injury
- Risk of bleeding based on other medical conditions (high blood pressure, infections, alcoholism, chronic liver disease, peptic ulcer) or medications such as aspirin
- Potential side effects of ITP therapies
- Your own preferences
In children, idiopathic thrombocytopenic purpura usually runs its course without the need for treatment. About 80 percent of children with idiopathic thrombocytopenic purpura recover completely within six months. Even in children who develop chronic ITP, complete recovery may still occur, even years later.
Adults with mild cases of ITP may require nothing more than regular monitoring and platelet checks. But if your symptoms are troublesome and your platelet count is low in relation to your lifestyle and risk of bleeding, you and your doctor may opt for treatment. Treatment usually consists of medications and, sometimes, surgery (splenectomy). Your doctor may also have you discontinue certain drugs that can further inhibit platelet function, such as aspirin, ibuprofen (Advil, Motrin, others) and the blood-thinning medication warfarin (Coumadin).
Medications
Common medications used to treat idiopathic thrombocytopenic purpura include:
-
Corticosteroids. The first line of therapy for ITP is a corticosteroid, usually prednisone, which can help raise your platelet count by decreasing the activity of your immune system. Once your platelet count is back to a safe level, you can gradually discontinue taking the drug under the direction of your doctor. In general, this takes about four to six weeks.
The problem is that about 70 percent of adults experience a relapse after discontinuing corticosteroids. A new course of corticosteroids may be pursued, but long-term use of these medications isn't recommended because of the risk of serious side effects, including cataracts, high blood sugar, increased risk of infections and loss of calcium from your bones (osteoporosis). You and your doctor will want to weigh the benefits of the medication against these risks. If you've taken corticosteroids for longer than three months, your doctor will likely recommend that you take calcium and vitamin D supplements to help maintain your bone density.
- Intravenous immune globulin (IVIG). If you have critical bleeding or need to quickly increase your blood count before an operation, you may receive medications such as immune globulin through a needle placed in your vein. These medications are quick and effective, but their benefits usually wear off in a couple of weeks.
Surgery
If you have severe ITP and an initial course of prednisone hasn't helped, surgical removal of your spleen (splenectomy) may be an option. This eliminates the main source of platelet destruction in your body and improves your platelet count within a few weeks. Splenectomy for ITP is not as routinely performed as it once was, however. Serious post-surgical complications sometimes occur, and not having a spleen permanently increases your susceptibility to infection. What's more, some people relapse even after splenectomy.
Splenectomy is rarely performed in children because of their high rate of spontaneous remission.
Emergency treatment
Although rare, severe bleeding can occur in anyone with ITP, regardless of age or platelet count. Severe or widespread bleeding is life-threatening and demands emergency care. This usually includes transfusions of platelet concentrates, intravenous methylprednisolone (a type of corticosteroid) and intravenous immune globulin.
Other treatments
If neither the initial round of corticosteroids nor a splenectomy has helped you achieve remission and your symptoms are severe, your doctor may recommend another course of corticosteroids, usually at the lowest effective dose.
Other possible treatments include:
- Immunosuppressant drugs. Medications that suppress the immune system, such as rituximab (Rituxan) — the most commonly used of this group — cyclophosphamide (Cytoxan) and azathioprine (Imuran) have been used to treat ITP, but they can cause significant side effects, and their effectiveness has yet to be proved.
- Experimental drugs. New medications that increase platelet production, especially eltrombopag and AMG 531, are being studied in clinical trials. Although they appear to be well tolerated, questions about long-term side effects remain.
- H. pylori treatment. A number of people with ITP are also infected with Helicobacter pylori (H. pylori), the same bacteria that cause most peptic ulcers. Eliminating the bacteria has helped increase platelet count in some people, but the results for this type of therapy are inconsistent and need to be studied further.
- ITP: Idiopathic thrombocytopenic purpura. American Academy of Family Physicians. http://familydoctor.org/online/famdocen/home/common/blood/113.html. Accessed July 31, 2008.
- What is idiopathic thrombocytopenic purpura? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/Itp/ITP_WhatIs.html. Accessed July 31, 2008.
- George JN. Treatment and prognosis of idiopathic thrombocytopenic purpura in adults. http://www.uptodate.com/home/index.html. Accessed July 31, 2008.
- Rodeghiero F. Idiopathic thrombocytopenic purpura: An old disease revisited in the era of evidence-based medicine. Haematologica. 2003; 88(10):1081-1087.
- Stasi R, et al. Management of immune thrombocytopenic purpura in adults. Mayo Clinic Proceedings. 2004;79(4):504-522. http://www.mayoclinicproceedings.com/pdf%2F7904%2F7904r.pdf.
- Bussel JB, et al. Eltrombopag for the treatment of chronic idiopathic thrombocytopenic purpura. New England Journal of Medicine. 2007;357(22):2237-2247. http://content.nejm.org/cgi/content/abstract/357/22/2237. Accessed July 31, 2008.
- Rodeghiero F. First-line therapies for immune thrombocytopenic purpura: Re-evaluating the need to treat. European Journal of Haematology. 2008; 80(69)(suppl):19-26.
- Newland A. Emerging strategies to treat chronic immune thrombocytopenic purpura. European Journal of Haematology. 2008;80(69)(suppl):27-33.
