Treatment Options for Idiopathic Thrombocytopenic Purpura (ITP)

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.

If adults or children who have ITP need treatment, medicines often are tried first. Corticosteroids, 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. If steroids, immunoglobulins, or splenectomy don’t help, two newer medicines – eltrombopag and romiplostim – 
can be used to treat ITP.

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.

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.