Therapy of ITP

The goal of treatment in ITP is not to restore the patient's platelet counts to normal but rather, to raise the platelet count to a "Safe Level" and thereby decrease the risk of life threatening hemorrhages.

What is considered a "Safe Platelet Level" for a particular patient is a clinical assessment made by the treating physician and depends on:

• the status of the patient
• underlying medical conditions
• lifestyle of the patient with level of physical activity which may place the patient at risk for an injury
• age of the patient

In North America , many treating physicians will consider treatment of Immune Thrombocytopenic Purpura when the platelet counts drop below 20,000 to 30,000. A "Safe Platelet Response" following treatment is an increase in platelet count of 20,000 from the pre-treatment level in most cases.

References:
Cines DB, Bussel JB : How I treat Idiopathic Thrombocytopenic Purpura : Blood,1 October 2005,Vol 106 No.7 pp2245-2251 Psaila B, Bussel JB: Immune Thrombocytopenic Purpura : Hematol Oncol Clin N Am(2007) 743-759

Management of ITP: Adults and Children

These are some of the treatment modalities presently being prescribed to treat patients with ITP:

1. Intravenous immunoglobulin (IVIG)
   • - Dose: 0.8 - 2g/kg daily for 1-5 days 1
2. Prednisone
• - Dose 1mg/kg daily for 21 days 2
3. Anti-D (WinRho ® SDF)
• - Dose: 50 µg/kg, 3-5 minute IV push3
4. Splenectomy
5. Cytotoxic agents: Cyclophosphamide, Vincristine
6. Immunosuppressive agents:Retuximab, Danazol, Cyclosporine A

Reference

1 Compendium of Pharmaceuticals and Specialties (CPS) 2005 Immune Globulin (Human) IV.
2 CPS 2005 Corticosteroids systemic CPha Monographs - pp. 529 - 531
3 Product Monograph for WinRho® SDF