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Immune thrombocytopenia (ITP) in adults: Treatment of chronic refractory disease


Although immune thrombocytopenia (ITP, previously called idiopathic thrombocytopenic purpura, immune thrombocytopenic purpura) is an acute, self-limited disease in the vast majority of children, it often relapses in adults following initial treatment with glucocorticoids, requiring additional treatment. (See "Treatment and prognosis of immune thrombocytopenia (ITP) in adults".)

Chronic refractory ITP is not common. A review of six case series suggested that less than 10 percent of adult patients initially diagnosed with ITP may eventually be considered to be refractory and require further treatment following failure of splenectomy [1].

The treatment of patients with chronic refractory ITP, defined here as a failure to respond to both splenectomy and rituximab, will be discussed here. Accordingly, the use of splenectomy and rituximab in the treatment of ITP is discussed elsewhere. (See "Treatment and prognosis of immune thrombocytopenia (ITP) in adults", section on 'Splenectomy' and "Treatment and prognosis of immune thrombocytopenia (ITP) in adults", section on 'Rituximab'.)

The clinical manifestations, diagnosis, and treatment of patients presenting with new-onset ITP are discussed separately. (See "Immune thrombocytopenia (ITP) in adults: Clinical manifestations and diagnosis" and "Treatment and prognosis of immune thrombocytopenia (ITP) in adults".)

Treatment of the patient with acute, severe bleeding, in preparation for surgery, or settings in which a rapid increase in platelet count is required, is discussed separately. (See "Treatment and prognosis of immune thrombocytopenia (ITP) in adults", section on 'Life-threatening bleeding and surgery'.)


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Literature review current through: Mar 2014. | This topic last updated: Apr 17, 2014.
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