ITP TREATMENT ALGORITHM

Acute ITP
Hemorrhage

<30,000 platelets/mm3

30,000 50,000 platelets/mm3

Platelet Transfusion
Prednisone (1-1.5 mg/kg/day)
IVIG 1 g/kg/day x 2-3 days
Anti-D (WinRho SDF)
Methylprednisolone 1 g/dayx3days

Prednisone or
no treatment

>50,000 platelets/mm3

No Treatment

Chronic Immune
Thrombocytopenic
Purpura

30,000 50,000
platelets/mm3

<30,000 platelets/mm3

Prednisone or
No treatment
Prednisone
Active Bleeding

No Active Bleeding
Anti-D (WinRho SDF)
IVIG

IVIG
Methylprednisolone
Splenectomy

Medical therapy

Danazol (10-15 mg/kg/day)

Dapsone (75 100 mg/day)

< 30,000 platelets/mm3

> 30,000 platelets/mm3

Splenectomy

Splenectomy

Continued Medical Therapy

Or Gradual discontinuation

Chronic,
Refractory
ITP
> 30,000 platelets/mm3
No treatment

< 30,000 platelets/mm3

No treatment

Inhibitor of platelet clearance

Prednisone
IVIG
Vinca alkaloids
Danazol

Medical therapy

Immunosuppressive drugs
Azathioprine
Cyclophosphamide
Cyclosporine

Experimental agents
monoclonal anti-CD20
monoclonal anti-CD154
Bone marrow transplantation
Thrombopoietin

Modified with permission from: Cines, Douglas B. and Blanchette Victor S: N Engl J Med, Vol 346, No. 13. March 28, 2002
Copyright2002 Massachusetts Medical Society