review | immune thrombocytopaenia

So you get an FBE in a well patient, with platelets that are noted to be 24, and the GP refers to you suspecting ITP. What other bloods do you need to order? What other major disorders do you need to exclude? Do you need to do a bone marrow? What’s the best way to treat?

A diagnosis of exclusion, and yet surprisingly common, ITP is one of those conditions you will definitely deal with at some point. Since 1950, we’ve known about the immune pathogenesis, but it’s still very complex.  Beyond the standard steroid therapy, there are a multitude of other options out there, including IVIg and anti-D, as well as brand new agents like thrombopoietin receptor antagonists (including one with possibly the best drug name ever, eltrombopag). 

The American Society of Haematology has released guidelines for the management in Blood – with a fantastic summary table that gets straight to the point. 

The guidelines are here.


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