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. In some cases, treatment may not be needed.

Medicines often are 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 often are treated. Adults who have milder cases of ITP may not need any treatment, other than watching 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), usually are treated.

Children who have milder cases of ITP may not need treatment other than monitoring and followup to make sure platelet counts return to normal.

Medicines

If adults or children who have ITP need treatment, medicines often are tried first. Corticosteroids (cor-ti-co-STEER-roids), such as prednisone, are commonly used to treat ITP.

These medicines, called steroids for short, help increase your platelet count by lowering the activity of your immune system. However, steroids have a number of side effects, and some people relapse (get worse) when treatment ends.

The steroids used to treat ITP are different from illegal steroids taken by some athletes to enhance performance. Corticosteroids aren't habit-forming, even if you take them for many years.

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

Medicines also may be used along with a procedure to remove the spleen, called splenectomy (splee-NECK-tuh-mee).

If steroids, immunoglobulins, or splenectomy don’t help, two newer medicines—eltrombopag and romiplostim—can be used to treat ITP.

Removal of the Spleen (Splenectomy)

If necessary, the spleen will be removed surgically. This organ is located in the upper left abdomen. The spleen is about the size of a golf ball in children and a baseball in adults.

The spleen makes antibodies (proteins) that help fight infection. In ITP, these antibodies destroy platelets.

If ITP hasn't responded to steroids, removing the spleen will reduce the destruction of platelets. However, it also may make you more likely to get certain infections. Before you have the surgery, your doctor may give you vaccines to help prevent these infections.

If your spleen is removed, your doctor will explain what steps you can take to help avoid infections and what symptoms to watch for.

Other Treatments

Platelet Transfusions

Some people with ITP who have severe bleeding may need to have platelet transfusions and be hospitalized. Some people 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. This increases the platelet count for a short time.

For more information on platelet transfusions, see the Diseases and Conditions Index Blood Transfusion article.

Treating Infections

Some infections can briefly lower a person's platelet count. If a person who has ITP has an infection that can lower his or her platelet count, treating the infection may help increase the platelet count and reduce bleeding problems.

Stopping Medicines

If a person who has ITP is taking medicine that can lower his or her platelet count or cause bleeding, stopping the medicine can sometimes help increase the platelet count or prevent bleeding.

For example, aspirin and ibuprofen are common medicines that increase the chance of bleeding. If you have ITP, your doctor may suggest that you avoid these medicines.