Treatment is considered for patients who have:
- A platelet count less than 30,000
- An upcoming operation or procedure that requires them to have a higher platelet count
- Active bleeding with a known diagnosis of ITP
If treatment is necessary, the most common treatments include:
- Corticosteroids ("steroids") — Steroids prevent bleeding by decreasing the production of antibodies against platelets. If effective, the platelet count will rise within two to four weeks of starting steroids. Side effects include irritability, stomach irritation, weight gain, difficulty sleeping, mood changes and acne.
- Intravenous gamma globulin ("IVIg") — IVIg slows the rate of platelet destruction temporarily. IVIg works quickly — within 24 to 48 hours — but its effect typically only lasts several days to a couple weeks.
If initial treatments are not effective, the following treatments can be tried:
- Rituximab ("Rituxan") — An antibody specifically directed against the type of immune system cells that can produce antibodies against platelets. This therapy may require up to four weekly infusions. The response to treatment is usually seen in four to six weeks after the first infusion, although it can take longer.
- Thrombopoietin mimetics (Eltrombopag/"Promacta" and Romiplostim/"Nplate") — These medications increase the bone marrow production of platelets. The FDA recently approved them for use in patients who do not respond to steroids. They generally work well to increase the platelet count.
- Splenectomy — Splenectomy is the surgical removal of the spleen, the location where most of the antibody-bound platelets are removed from the bloodstream. This can be an effective and permanent solution for patients with ITP, but they will be at risk for developing certain infections in the future.
In addition, individuals with ITP may need to make lifestyle changes, including: