How Is Idiopathic Thrombocytopenic Purpura Treated?

Treatment for idiopathic thrombocytopenic purpura (ITP) is based on how much and how often you’re bleeding and your platelet count. Medicines are often used as the first course of treatment. Treatments used for children and adults are similar.

Adults with ITP who have very low platelet counts or problems with bleeding are usually treated. Adults who have milder cases of ITP may not need any treatment, other than monitoring their symptoms and platelet counts.

The acute (short-term) type of ITP that occurs in children often goes away within a few weeks or months. Children who have bleeding symptoms, other than merely bruising (purpura), are usually treated. Milder cases in children may not need treatment other than monitoring and followup to be sure platelet counts return to normal.

Medicines

If treatment is needed for adults or children who have ITP, medicines are usually used first. Corticosteroids (cor-ti-co-STEER-roids), such as prednisone, are commonly used to treat ITP. These medicines, called steroids for short, help raise the platelet count in the blood by lowering the activity of the immune system. However, steroids have a number of side effects, and some people relapse (get worse) when treatment ends.

Some medicines used to help raise the platelet count are given through a needle in a vein. These medicines include immune globulin and anti-Rh (D) immunoglobulin.

Experimental medicines may be tried if these treatments don’t help. Medicines may be used along with a procedure to remove the spleen, called splenectomy (splee-NECK-tuh-mee).

Removal of the Spleen (Splenectomy)

If necessary, the spleen will be removed surgically. This organ is located in the upper left abdomen and is about the size of a golf ball in children and a baseball in adults. If ITP hasn’t responded to steroids, removing the spleen will reduce the destruction of platelets, but it also may make you more likely to get certain types of infections. If your spleen is removed, discuss with your doctor steps you can take to help avoid these infections and the symptoms to watch out for.

Other Treatments

Platelet Tansfusions

Some people with ITP who have severe bleeding may need to have platelet transfusions and be hospitalized. Some will need a platelet transfusion before having surgery. For a platelet transfusion, donor platelets from a blood bank are injected into the recipient's bloodstream to increase the platelet count for a short time.

Treating Infections

Some types of infections can briefly lower a person’s platelet count. If a person with ITP has an infection that can lower the number of platelets, treating the infection may help raise the platelet count and reduce bleeding problems.

Stopping Medicines

If a person who has ITP is taking medicine that can lower the number of platelets or cause bleeding, stopping the medicine can sometimes help raise the platelet count or prevent bleeding. For example, aspirin and ibuprofen are common medicines that reduce platelet function and increase the chance of bleeding. If you have ITP, you shouldn’t use these medicines.