First-Line Therapy for Immune Thrombocytopenia

Siraj Mithoowani; Donald M Arnold

doi:10.1055/s-0039-1684031

First-Line Therapy for Immune Thrombocytopenia

Hamostaseologie. 2019 Aug;39(3):259-265. doi: 10.1055/s-0039-1684031. Epub 2019 Jun 6.

Authors

Siraj Mithoowani¹, Donald M Arnold^{1

2

3}

Affiliations

¹ Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
² McMaster Centre for Transfusion Research, Hamilton, Ontario, Canada.
³ Canadian Blood Services, Hamilton, Ontario, Canada.

PMID: 31170773
DOI: 10.1055/s-0039-1684031

Abstract

Immune thrombocytopenia (ITP) is an autoimmune disease affecting blood platelets that causes thrombocytopenia and an increased risk of bleeding. First-line therapy is indicated for patients with bleeding complications or who are at increased risk of bleeding, and the decision to initiate therapy depends not only on the platelet count, but also on other endpoints including quality of life. The choice of first-line therapy depends primarily on how quickly a platelet count response is required, with intravenous immune globulin providing the more rapid response, followed by high-dose dexamethasone and prednisone. In this narrative review, we discuss key issues with first-line therapy in ITP including when to initiate therapy, treatment options and special considerations for children. Evidence-based guidelines are lacking for the emergency management of patients with ITP who present with significant bleeding; we provide our approach to this critical situation.

Georg Thieme Verlag KG Stuttgart · New York.

Publication types

Comparative Study
Review

MeSH terms

Acute Disease
Adolescent
Adult
Autoimmune Diseases / epidemiology
Autoimmune Diseases / therapy
Blood Platelets / drug effects*
Blood Platelets / immunology
Blood Platelets / pathology
Child
Child, Preschool
Dexamethasone / administration & dosage
Dexamethasone / therapeutic use
Emergencies / epidemiology
Female
Glucocorticoids / administration & dosage
Glucocorticoids / therapeutic use
Hemorrhage / complications
Hemorrhage / mortality
Humans
Immunoglobulins, Intravenous / administration & dosage
Immunoglobulins, Intravenous / adverse effects
Immunoglobulins, Intravenous / therapeutic use*
Infant
Male
Middle Aged
Prednisone / administration & dosage
Prednisone / therapeutic use
Purpura, Thrombocytopenic, Idiopathic / epidemiology
Purpura, Thrombocytopenic, Idiopathic / psychology
Purpura, Thrombocytopenic, Idiopathic / therapy*
Quality of Life
Risk Assessment
Thrombosis / chemically induced*
Thrombosis / epidemiology

Substances

Glucocorticoids
Immunoglobulins, Intravenous
Dexamethasone
Prednisone