Immune thrombocytopenia (ITP) in adults: Initial treatment and prognosis
- James N George, MD
James N George, MD
- Professor of Medicine
- University of Oklahoma Health Sciences Center
- Donald M Arnold, MD, MSc
Donald M Arnold, MD, MSc
- Associate Professor, Department of Medicine
- McMaster University
Immune thrombocytopenia (ITP) is an acquired form of thrombocytopenia due to autoantibody-mediated destruction of platelets. The autoantibodies also affect megakaryocytes and impair platelet production. ITP is a diagnosis of exclusion, characterized by isolated thrombocytopenia and the lack of a clinically-apparent condition responsible for the low platelet count; there are no reliable laboratory tests to confirm the diagnosis. (See "Immune thrombocytopenia (ITP) in adults: Clinical manifestations and diagnosis".)
The major initial decisions regarding treatment are whether the patient needs any therapy, and if so, which therapy to use. These decisions can be challenging because the goal of treatment is to prevent severe bleeding, but the risk of bleeding can be difficult to estimate for any individual patient. Severe bleeding is rare, and patients may be more likely to develop complications from the toxicities of therapy than they are to have severe bleeding.
The initial treatment and prognosis of ITP in adults is reviewed here. Second--line therapies for adults who require additional treatment, and the management of ITP in children, who have a different clinical course from adults, are discussed separately. (See "Immune thrombocytopenia (ITP) in adults: Second-line and subsequent therapies" and "Immune thrombocytopenia (ITP) in children: Initial management" and "Immune thrombocytopenia (ITP) in children: Management of chronic disease".)
We use the following terms herein; this terminology is consistent with a consensus statement from an international working group on ITP published in 2009 :
●Primary ITP – Primary ITP is acquired thrombocytopenia due to autoimmune platelet destruction, not triggered by an associated condition. (See "Immune thrombocytopenia (ITP) in adults: Clinical manifestations and diagnosis".)
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- OVERVIEW OF OUR APPROACH
- Indications for treatment
- Other therapeutic considerations
- Hematologist referral
- TREATMENT OF BLEEDING
- FIRST-LINE THERAPIES
- Choice of first-line therapy
- SECOND-LINE THERAPIES
- SPECIAL SCENARIOS
- Surgery/invasive procedures
- Myelosuppressive chemotherapy
- ITP during pregnancy
- Secondary ITP
- Helicobacter pylori infection
- High risk physical activities
- Disease course
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS