Goals of treatment
Once other conditions that may cause low platelets are ruled out, and a diagnosis of ITP is made, a treatment plan can be developed based on the patient's complete medical condition and lifestyle.1
The first goal of ITP treatment is to lower the chances of uncontrolled bleeding (including internal bleeding) by raising the platelet count to a level where the chance of uncontrollable bleeding is low. Not all patients experience bleeding symptoms at the same platelet count and some patients may have no bleeding symptoms or only very mild symptoms at low platelet counts.2 Generally, doctors want to raise platelet levels over 50,000 per microliter of blood. At this platelet count the risk of uncontrolled bleeding is thought to be low for all patients. Another treatment goal may be to alleviate the ITP Symptoms and Signs (such as bruising).
Because ITP is due to increased platelet destruction and decreased platelet production, treatments that help to manage ITP work on these processes.
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Types of treatment
Medical treatments that slow platelet destruction
In ITP, the body's immune system, for unknown reasons, destroys healthy blood platelets. It also impairs the body's ability to produce platelets. Slowing the destruction of platelets is one approach to ITP treatment. Most treatments for ITP interfere with the immune system to help reduce platelet destruction. Some of these treatments are FDA approved for ITP and some are not. Many of these treatments are immunosuppressants.4
Medical treatments that increase platelet production
In recent years, it has become clearer that there is an additional process involved in ITP: The body doesn’t produce enough platelets to make up for the healthy platelets that are destroyed. An alternative approach works to increase platelet production4—supporting a normal process in the body.
Platelet boosters. These are medicines that do not work on the immune system, but instead imitate thrombopoietin, or TPO. TPO is the protein that tells special cells in the bone marrow called megakaryocytes to produce platelets. By doing this, platelet boosters help increase platelet production.4,5
Click here to read more about what experts say about platelet boosters, also called TPO-receptor agonists. Please note: if you click this link, you will
Splenectomy: surgical treatment that slows the removal of platelets
Splenectomy is the permanent surgical removal of the spleen. The spleen is a part of the immune system that removes aging or defective blood cells, including platelets, makes some antibodies, and removes any cells or bacteria that are coated with antibodies from the body.10 Without the activities of the spleen, platelets are likely to stay in the blood longer. However, the spleen has other immune functions that your doctor may consider when deciding if a splenectomy is recommended.11 A panel of ITP experts recommended that most patients should wait at least 6 months after diagnosis before having a splenectomy because of patient preferences or the possibility of remission of symptoms on their own.4 You should discuss all available options with your healthcare provider.
The International Consensus Report, published in January 2010, was written by a panel of ITP experts. It recommends several treatment options after an insufficient response to corticosteroids. These treatment options include immunosuppressants, platelet boosters, or splenectomy.4
Different treatments for ITP have various benefits and risks. Always follow the recommendations of your healthcare professional.
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