ITP

Question 1

What is the “Goal” of treatment for ITP?

Answer 1

To reduce the risk of “Clinically Significant Bleeding”,

Hence, patients with PLT counts > 30,000 only need clinical monitoring.

Question 2

What is the initial treatment for ITP?

Answer 2

Dexamethasone or Methylpred [IV] / Prednisone [PO] + IVIG (if steroid refractory) or sooner based on severity

Can use Dexamethasone 40 mg [PO] daily x 4 days.

Question 3

What patient’s need treatment verse just clinical monitoring?

Answer 3

1) Pt with PLT > 30,000 and NO bleeding – can be monitored
2) Pt with PLT > 30,000 and any form of bleeding — should receive at least steroids +/- IVIG

3) Pt with severe clinical bleeding (Intracranial Hemorrhage or active GI bleeding) and PLT < 30,000 should receive platelet transfusion + the treatment above.

Question 4

What are 4 diseases that can cause secondary Immune Thrombocytopenia and thus should be ruled out in the workup of ITP?

Answer 4

1) HIV
2) HCV
3) SLE
4) CLL (think of association with autoimmune hemolytic anemia, as this is similar)

Question 5

What other therapies can be used as treatment?

Answer 5

1) Rituximab
2) Eltrombopeg (TPO agonist)
3) Splenectomy

Others

4) Danazol
5) Vincristine

Question 6

Pts older than 60 years old with suspicion definately need what procedure to rule out other etiologies?

Answer 6

Bone Marrow Biopsy

Anyone > 60 with decreasing PLT count and suspicion of new heme-onc disease, to rule out MDS or other Bone Marrow causes.