Unlike ITP in children, ITP in adults does not often resolve spontaneously. Thus, for a newly diagnosed adult with ITP, the first question is whether treatment is needed. The goal of treatment is to reduce the risk of bleeding, not to normalize the platelet count; and all therapies for ITP are associated with risks (eg, immunosuppression). (See 'Indications for treatment' below.)
Additional issues for those who require therapy to reduce the risk of bleeding include:
●Deciding how rapidly the platelet count needs to be raised, which determines whether glucocorticoids or intravenous immune globulin (or rarely, platelet transfusions) are needed.
●Determining the optimal second-line therapy for those who do not benefit from glucocorticoids, because the options for second-line therapy vary substantially in their toxicity profiles.
The initial treatment, second-line management, and prognosis of ITP in adults will be reviewed here. Treatment of chronic and refractory ITP, the clinical manifestations, diagnosis, and differential diagnosis of ITP in adults, and issues related to ITP in children are discussed separately.