what is the best treatment for itp

^{Medications to treat ITP may include:}

• Steroids. Your doctor will likely start you on an oral corticosteroid, such as prednisone. ...
• Immune globulin. If corticosteroids don't help, your doctor may give you an injection of immune globulin. ...
• Drugs that boost platelet production. Medications such as romiplostim (Nplate) and eltrombopag (Promacta) help your bone marrow produce more platelets. ...
• Other drugs. Rituximab (Rituxan, Truxima) helps increase your platelet count by reducing the immune system response that's damaging your platelets. ...

What s the best treatment to get rid of ITP?

Homeopathic remedies for ITP (Idiopathic Thrombocytopenic Purpura) Lachesis is one of the best homeopathic remedies for ITP. The patient gets bluish as well as blackish bruises and trembling tongue like a snake is the main symptom of Lachesis. It is another homeopathic medicine for ITP treatment.

What is the optimal treatment of ITP?

Which treatments are available for ITP?

• Corticosteroids. Corticosteroids have been used as a first-line treatment for ITP for more than 30 years, according to available research from 2016.
• Thrombopoietin receptor antagonists. ...
• Antibody therapy. ...
• Immunoglobulin infusions. ...
• Avoiding certain medications and supplements. ...
• Splenectomy. ...
• Antibiotics. ...
• Lifestyle changes. ...

What are the drugs to avoid in ITP?

• Drug administration preceded thrombocytopenia; recovery from thrombocytopenia complete and sustained after drug discontinued
• Other drugs administered prior to thrombocytopenia were continued or reintroduced after discontinuation of the suspected drug
• Other etiologies of thrombocytopenia excluded

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Is there any cure for ITP?

There is no cure for ITP and treatment is used to raise the platelet count to counteract symptoms. First line treatments include prednisolone and intravenous immunoglobulin (under various brand names).

What is the latest treatment for ITP?

Newer treatments, such as the thrombopoietin receptor agonists, have transformed ITP care. They have high efficacy, are well tolerated and improve patients' quality of life. A greater understanding of the underlying pathophysiology of this disorder has helped develop a number of new targeted therapies.

Can ITP be cured completely?

Can ITP be cured completely? Chronic ITP isn't curable. With chronic ITP, you'll have remission periods when your symptoms improve for months or even years. But eventually chronic ITP symptoms recur.

What is the first line treatment for ITP?

The standard initial treatment for ITP is oral corticosteroids to increase platelet counts. Intravenous immunoglobulin or anti-D immunoglobulin can also increase platelet counts and are particularly useful for stimulating rapid platelet increases before planned procedures.

What treatments are available for ITP?

Medications to treat ITP may include:Steroids. Your doctor will likely start you on an oral corticosteroid, such as prednisone. ... Immune globulin. If corticosteroids don't help, your doctor may give you an injection of immune globulin. ... Drugs that boost platelet production. ... Other drugs.

Which medicine is best to increase platelets?

Romiplostim injection is used to increase the number of platelets (cells that help the blood to clot) in order to decrease the risk of bleeding in adults who have immune thrombocytopenia (ITP; idiopathic thrombocytopenic purpura; an ongoing condition that may cause easy bruising or bleeding due to an abnormally low ...

Does ITP get worse with age?

Does it get worse over time? No, unlike autoimmune diseases such as rheumatoid arthritis and multiple sclerosis it is not a progressive disease, but the risk of bleeding is present from the day the disease develops. ITP can go into temporary or permanent remission.

How is ITP 2021 treated?

In adults with newly diagnosed ITP, the ASH guideline panel recommends against a prolonged course (>6 weeks) of prednisone in favor of a short course (≤6 weeks) and suggests either prednisone (0.5 - 2.0 mg/kg/day) or dexamethasone (40 mg/day for 4 days) as the type of corticosteroid for initial therapy1 .

How long should I take steroids for ITP?

In light of the heavy treatment burden of prolonged corticosteroid exposure, clinical practice guidelines recommend limiting corticosteroid treatment to no more than 6 weeks in adults with ITP receiving initial therapy.

How long does it take for steroids to work for 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.

How fast does rituximab work for ITP?

Rituximab is a chimeric monoclonal antibody targeting a B-cell antigen (CD20) that has been used widely as a second line therapy for ITP with a promising response rate approaching 60% in some studies. A response is usually seen between week one to eight of therapy and could last for five years in some patients.

How can I increase my platelets quickly?

8 Things That Can Increase Your Blood Platelet CountEating more leafy greens. ... Eating more fatty fish. ... Increasing folate consumption. ... Avoiding alcohol. ... Eating more citrus. ... Consuming more iron-rich foods. ... Trying a chlorophyll supplement. ... Avoiding vitamin E and fish oil supplements.

What is the main cause of ITP?

Immune thrombocytopenia usually happens when your immune system mistakenly attacks and destroys platelets, which are cell fragments that help blood clot. In adults, this may be triggered by infection with HIV , hepatitis or H. pylori — the type of bacteria that causes stomach ulcers.

What is the treatment for ITP?

In recent years, the number of treatment options available for patients with immune thrombocytopenia (ITP) has expanded. In addition to the classical trio of corticosteroids, intravenous immunoglobulin, and splenectomy, choices now include rituximab, thrombopoietin receptor agonists (TPO-RAs), and the tyrosine kinase inhibitor fostamatinib. However, a lack of randomized clinical trials evaluating the management of ITP has led to significant variation in practice patterns and lack of consensus regarding treatment options.

What is the recommended platelet count for ITP?

Most guidelines for adult patients with ITP recommend initiating treatment when a platelet count is less than 20 to 30×10 9 /L. However, this recommendation is based on limited, if any, evidence. There may be a subset of patients who would not require treatment even below this level.

What is the second line for ITP?

Dr. Neunert: For patients with corticosteroid-dependent ITP or whose disease was unresponsive to corticosteroids, second-line options include splenectomy, rituximab, TPO-RAs, and, most recently, fostamatinib. At first, people were hopeful that rituximab would be a “magic bullet” for everyone with ITP; initially reported response rates were high, but, as we have seen, many patients do not respond or lose response over time.

What is the ASH guidelines for ITP?

The ASH guidelines also differentiate hospitalization in someone newly diagnosed with ITP and a patient with whom you are familiar. With a new ITP diagnosis, you do not yet know how he/she will respond to treatment or what his/her bleeding pattern will be.

Do ER doctors treat ITP?

Dr. Neunert: Yes, many newly diagnosed patients are managed by ER doctors and internal medicine hospitalists rather than hematologists. There are nuances to ITP treatments, which is why it is important for patients to follow up with clinicians who have experience with this condition.

Does Rituximab help with ITP?

At first, people were hopeful that rituximab would be a “magic bullet” for everyone with ITP; initially reported response rates were high, but, as we have seen, many patients do not respond or lose response over time. However, rituximab has many benefits, including the fact that there is no need for ongoing therapy.

How long does it take for an ITP to heal?

Many children with ITP are able to spontaneously recover within six months.

What is ITP in children?

Type of ITP (acute versus chronic) Severity and extent of the disorder. Your child's tolerance for specific medications, procedures or therapies. You and your child's expectations, opinions and preferences.

How to treat a spleen infection?

Other treatment options may include: 1 Rh immune globulin: Temporarily stops the spleen from destroying platelets. Your child must be Rh positive and have a spleen for this medication to be effective. 2 Medication changes: If we suspect that your child's medication is causing the ITP, we will recommend discontinuing or changing the medication. 3 Infection treatment: If an infection is causing the ITP, then treating the infection may result in higher platelet counts. 4 Splenectomy: In some cases, the child's spleen may need to be removed, since this is the most active site of platelet destruction. We consider this option more often in older children and adults with chronic ITP to decrease the rate of platelet destruction. 5 Hormone therapy: Teenage girls may need to take hormones to stop their menstrual cycle when their platelets are low if excessive bleeding occurs. 6 Medicines: The FDA approved two new medications for ITP: N-plate and Promacta. They stimulate the bone marrow to produce more platelets.

What are the two most common forms of treatment for a swollen ear?

If we decide treatment is necessary, the two most common forms of treatment are steroids and intravenous gamma globulin:

How long does it take to treat ITP?

According to 2019 guidelines from the American Society of Hematology (ASH), adults newly diagnosed with ITP should be treated with prednisone for no more than 6 weeks. Most children with ITP don’t require treatment. However, corticosteroids are used as first-line treatments for children who do require treatment.

What is the goal of ITP?

The goal of ITP treatment is to improve platelet counts and reduce the risk of bleeding. Corticosteroids are often prescribed as first-line treatments for adults, but a variety of options are available. ITP in children typically resolves in 6 months ...

Why does ITP cause low platelets?

With ITP, your immune system attacks and destroys platelets because it sees them as foreign tissue. In turn, low levels of blood platelets lead to your symptoms and related conditions. Taking a thrombopoietin receptor antagonist — a type of medication — can increase your platelet count.

How long have corticosteroids been used for ITP?

Corticosteroids have been used as a first-line treatment for ITP for more than 30 years, according to available research from 2016. They can be given orally or intravenously.

When to use IVIG?

IVIG can be used before surgery or in other instances when you need to increase your platelet count right away.

What is the best treatment for a pregnant woman?

The preferred treatment for pregnant women is daily oral prednisone, according to a 2017 research review.

When is a splenectomie safe?

Splenectomies are safe through the second trimester, but they’re rarely necessary.

What is the best treatment for CITP?

Doctors usually try steroids first. They’re similar to a hormone made by your adrenal glands. You’ll probably get one of two types to help treat your cITP.

How to treat CITP?

It helps slow the breakdown of your platelets. You take it as a pill every day for 2 to 4 weeks, then slowly lower the dose until you’re off it completely .

What are the drugs that help with platelets?

Drugs in this class include: avatrombopag ( Doptelet), eltrombopag ( Promacta ), and romiplostim ( Nplate). They help your body make more platelets and may also boost your immune system.

What is the name of the drug that is used to treat thrombocytopenia?

Intravenous Immune Globulin (IVIG) Anti- RhoD (Anti-D ) Thrombopoietin-Receptor Agonists (TPO-RAs) Fostamatinib (Tavalisse) Rituximab (Rituxan) When you have chronic immune thrombocytopenia (cITP), you don’t have enough platelets in your blood. This means you might bleed if your platelet count is low or bleed too much when you’re injured.

What is the best medicine to stop bleeding?

Intravenous Immune Globulin (IVIG) This is also often used first. Your doctor may prescribe it to stop bleeding fast. Immune globulins are proteins in your blood called antibodies. Your immune system makes them to fight germs. You can also get them from a blood donor to boost your platelet count.

Why do you take medicine before treatment?

You take medicine before the treatment and at home to help lower your chance of problems.

Can you take tavalisse twice a day?

Fostamatinib (Tavalisse) This is a tablet you take twice a day. It helps create more blood platelets for some people who weren’t helped by other treatments. For most people, side effects are mild. But in rare cases it can make you less able to fight infections, raise your blood pressure, or cause liver problems.

What is itp in blood?

Immune thrombocytopenic purpura (ITP) is a blood disorder characterized by a decrease in the number of platelets in the blood. Platelets are cells in the blood that help stop bleeding. A decrease in platelets can cause easy bruising, bleeding gums, and internal bleeding. This disease is caused by an immune reaction against one's own platelets. It has also been called autoimmune thrombocytopenic purpura.

How long does it take for ITP to go away?

There are two forms of ITP: Acute thrombocytopenic purpura. This usually affects young children, ages 2 to 6 years old. The symptoms may follow a viral illness, such as chickenpox. Acute ITP usually starts suddenly and the symptoms usually disappear in less than 6 months, often within a few weeks.

What is thrombocytopenic purpura?

Idiopathic thrombocytopenic purpura is a blood disorder characterized by an abnormal decrease in the number of platelets in the blood. A decrease in platelets can result in easy bruising, bleeding gums, and internal bleeding. ITP may be acute and resolve in less than 6 months, ...

What is the normal platelet count for thrombocytopenic purpura?

What are the symptoms of idiopathic thrombocytopenic purpura? Normal platelet count is in the range of 150,000 to 450,000. With ITP, the platelet count is less than 100,000. By the time significant bleeding occurs, you may have a platelet count of less than 10,000.

How long does thrombocytopenic purpura last?

Chronic thrombocytopenic purpura. The onset of the disorder can happen at any age, and the symptoms can last a minimum of 6 months, several years , or a lifetime. Adults have this form more often than children do, but it does affect adolescents. Females have it more often than males.

Does ITP cause increased bleeding?

The lower the platelet count , the greater the risk of bleeding. Because platelets help stop bleeding, the symptoms of ITP are related to increased bleeding. However, each person may experience symptoms differently. Symptoms may include:

What is the first line of treatment for idiopathic ITP?

For primary idiopathic ITP, corticosteroids have been the standard first-line of treatment for symptomatic patients, with the addition of intravenous immune globulin (IVIG) or Rho(D) immune globulin (anti-RhD) for steroid-resistant cases.

What is ITP in medical terms?

Immune thrombocytopenic purpura (ITP) is an autoimmune condition that affects nearly 1:10,000 people in the world. It is traditionally defined by a platelet count of less than 100 x 109L, but treatment typically depends on symptomology rather than on the platelet count itself.

What is the goal of ITP therapy?

(1) The goal of therapy in this population is to maintain a hemostatic platelet count while minimizing drug-induced toxicity; select patients may require somewhat higher platelet counts because of comorbid risk factors as discussed in “Treatment of chronic ITP.”.

What is ITP in pregnancy?

ITP occurs in 1 per 1000 to 1 per 10 000 pregnancies, accounting for approximately 3% of women who are thrombocytopenic at delivery. 76 In addition to the differential diagnosis common to all patients with possible ITP, consideration should be given to causes of thrombocytopenia confined to or more common during pregnancy, including pregnancy-induced hypertension and related conditions such as hemolysis, elevated liver enzymes, and low platelet count (HELLP), obstetric causes of disseminated intravascular coagulation, microangiopathic hemolytic processes, and gestational thrombocytopenia, among others (for a review, see McCrae et al 77 ). The latter, also referred to as incidental or benign thrombocytopenia of pregnancy, is found in 5% to 8% of healthy women with an uneventful pregnancy and accounts for at least 75% of all cases of thrombocytopenia at term. 78, 92 Thrombocytopenia is generally mild (platelet counts > 70 000 × 10 9 /L in 95% of cases) and there seems to be no impact on maternal or fetal health. Platelet counts generally return to normal within 2 months after delivery. ITP should be suspected any time during pregnancy if isolated thrombocytopenia of less than 50 000 × 10 9 /L is detected, especially during the first 2 trimesters, but the distinction from gestational thrombocytopenia may occasionally be problematic in the absence of a prenatal platelet count as both entities are diagnoses of exclusion.

How many ITP neonates have thrombocytopenia?

Approximately 4% of ITP neonates are born with severe thrombocytopenia (platelet counts < 20 000 × 10 9 /L), but importantly few have platelet counts that are less than 5000 × 10 9 /L unless alloantibodies are also present. 87 The severity of neonatal thrombocytopenia is often most marked 1 to 3 days after birth.

How often should I monitor my platelet count?

In the absence of symptoms or treatment, we monitor platelet counts at least monthly through the first 2 trimesters, biweekly in the third, weekly as term approaches and more often, if indicated. Ideally, maternal platelet counts should be maintained above 20 000 × 10 9 /L throughout pregnancy and above 50 000 × 10 9 /L near term to minimize the need for platelet transfusions in the event an emergency cesarean section is required, 2, 3, 79 but a higher platelet count may be required for epidural anesthesia. We generally use corticosteroids as initial therapy, but this can induce or exacerbate gestational diabetes, bone loss, hypertension, and perhaps abruption and prematurity. 80 For this reason, we tend to rely more on IVIG together with low-dose prednisone (20 mg every day) than in nonparous patients. We have recently found IV anti-D to be safe (including for the newborn) and effective, although experience is limited, caution is indicated, and close monitoring of the fetus with sonograms and the newborn with hemoglobin and bilirubin determinations is warranted. 81 Splenectomy should be avoided if possible, and deferred to the second trimester when necessary, to avoid abortion. We do not use danazol, cyclophosphamide, anti-CD20, vinca alkaloids, and other potentially teratogenic therapy (with the possible exception of azathioprine for which a registry exists for renal transplant recipients 83 ). There is limited experience with chemotherapy for neoplastic diseases in pregnant women that may be helpful in managing the truly exceptional case (for reviews, see Koren et al 84 and Weisz et al 85 ).

What is the goal of thrombocytopenia treatment?

Alternatives are substituted for drugs deemed necessary but potentially causal. The initial goal of treatment is to attain a hemostatic platelet count (≥ 30 000 × 10 9 /L) while minimizing the toxicity of treatment. Figure 1 shows our treatment algorithm for initial management. The reader is referred elsewhere for a more comprehensive tabulation of drug doses, expected response times, and common side effects. 30 Therapy is indicated in all patients who present with bleeding and those with platelet counts less than 20 000 × 10 9 /L because fewer than 10% of adults rapidly attain spontaneous remission. Those with platelet counts more than 50 000 × 10 9 /L can almost always be observed, although some (5 of 87 in one series 7 ) require treatment later. In general, immediate therapy is not required for patients with platelet counts between 20 000 and 50 000 × 10 9 /L in the absence of bleeding or predisposing comorbid conditions such as uncontrolled hypertension, active peptic ulcer disease, anticoagulation, recent surgery, or head trauma. 2, 3 We recommend maintaining platelet counts above 40 000 to 50 000 × 10 9 /L for patients requiring aspirin, nonsteroidal anti-inflammatory drugs, warfarin, or other antithrombotics.

What is the normal platelet count for a purpura?

Patients typically present with petechiae or purpura that develop over several days accompanied by platelet counts less than 20 000 × 10 9 /L, although the onset is often more insidious than previously appreciated. 10 Severe cutaneous bleeding, prolonged epistaxis, gingival bleeding, overt hematuria, or menorrhagia may develop at platelet counts less than 10 000 × 10 9 /L. Spontaneous or posttraumatic ICH or bleeding at other internal sites is uncommon, but not without precedence, 24 at platelet counts between 10 000 and 20 000 × 10 9 /L. Those with platelet counts between 30 000 and 50 000 × 10 9 /L may note easy bruising, whereas platelet counts above 50 000 × 10 9 /L are usually discovered incidentally. Rarely, do patients present with bleeding disproportionate to the platelet count because of antibody-induced platelet dysfunction. 29 Some patients experience untoward and otherwise unexplained fatigue when their platelet count is low.

What age is the average ITP?

Until recently, experience from numerous centers over more than a half-century indicated that the typical adult with ITP is a woman, generally between 18 and 40 years of age. 6 Gender disparity largely disappears among the elderly. 6, 7 Two recent publications have questioned this perception. The first was a survey from a single county in Denmark using International Classification of Disease (ICD) codes at hospital discharge over a 22-year period. The female-male ratio was 1.7, the median age at diagnosis was 56 years, and the incidence of ITP increased with age and increased overall during the period of study. 8 The second was a prospective cohort analysis of newly presenting adults with platelet counts less than 50 000 × 10 9 /L in the Northern Health Region of the United Kingdom. The female-male ratio was 1.2 and, again, the age-specific incidence was highest among those older than 60 years. 9 Presenting symptoms, severity of thrombocytopenia, and response to therapy were typical for ITP, so these data do not simply reflect increased detection of mild cases based on automated platelet determinations, 10 misdiagnosed myelodysplasia (MDS), 11 or drug-dependent antibodies.

Idiopathic thrombocytopenic purpura (ITP) care at Mayo Clinic

Your multidisciplinary team of experts will include doctors who specialize in diseases of the blood and blood cells (hematologists), along with other specialists as needed. They collaborate to provide coordinated care.

Expertise and rankings

Mayo Clinic's immune thrombocytopenia (ITP) experts provide comprehensive care for more than 600 adults and children with ITP each year.

Locations, travel and lodging

Mayo Clinic has major campuses in Phoenix and Scottsdale, Arizona; Jacksonville, Florida; and Rochester, Minnesota. The Mayo Clinic Health System has dozens of locations in several states.

Costs and insurance

Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people.

What is the second line treatment for thrombopoietin?

Other second-line treatment options are rituximab and splenectomy.

What is the treatment decision for a patient with a higher platelet count?

Individual treatment decisions for patients with higher platelet counts are made on the basis of patient-specific factors and history of bleeding. For example, if a patient is undergoing a procedure that requires a higher platelet count for safety, then that patient needs to be treated.

Is bleeding a symptom of ITP?

Interestingly, the risk for bleeding is generally lower in ITP than in other disorders causing thrombocytopenia. Even when patients have severely low platelet counts, they most often present with only minor symptoms of bleeding, such as acute petechiae or purpura. The bleeding is generally not life-threatening.

Is ITP curative?

JC The decision to start treatment in adults with ITP is guided by the platelet count and symptoms of bleeding. ITP is a chronic condition. Treatment is not curative, so even when remission is achieved, relapses may occur, sometimes years later. The goal of therapy is to reduce the risk for bleeding so patients can live effectively normal lives. Interestingly, the risk for bleeding is generally lower in ITP than in other disorders causing thrombocytopenia. Even when patients have severely low platelet counts, they most often present with only minor symptoms of bleeding, such as acute petechiae or purpura. The bleeding is generally not life-threatening. The reason for this is still something we are trying to understand. That said, great heterogeneity is found among adults with ITP. Death from hemorrhage is rare in this disease, but it does happen.

Is JC ITP a chronic disease?

JC ITP is a treatable chronic disease. Because treatment is generally not curative and relapses can occur years later, the goal of therapy is to stabilize the platelet count in a safe range, not necessarily to normalize the count. A response is achieved in the majority of patients, although some may require multiple rounds of therapy over time. Patients whose platelet counts are greater than 30,000/μL to 50,000/μL may be regularly monitored, and because drops in platelet counts can be precipitous, they should also receive counseling about signs and symptoms that require urgent evaluation.

Can I take IVIG with corticosteroids?

Intravenous immunoglobulin (IVIG) and anti-D therapy are still frontline options for patients in whom corticosteroids are contraindicated. IVIG also can be used in combination with corticosteroids should a faster response time be important.

Is antiplatelet antibody testing recommended for ITP?

Although antiplatelet antibody testing is available, it is not recommended in the evaluation of ITP because it has not been shown to be sensitive or specific. Antiplatelet antibody testing neither confirms nor excludes the diagnosis. Approximately 50% of patients with ITP have antiplatelet antibodies, and they may also be detected in individuals with other causes of thrombocytopenia. The presence or absence of antiplatelet antibodies does not correlate with outcomes.

Diagnosis

• To diagnose immune thrombocytopenia, your doctor will try to exclude other possible causes of bleeding and a low platelet count, such as an underlying illness or medications you or your child may be taking. Blood tests can check the levels of platelets. Rarely, adults might need a bone m…

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