Immune thrombocytopenia (ITP) Adult

Specialty: Hematology

Recommendations:

Acute ITP with or at risk for severe bleeding: IVIG is recommended as part of multimodality therapy for patients with ITP, severe thrombocytopenia (platelets less than 30 x 109/L) and severe bleeding.

IVIG may be considered in the following situations: 

• ITP in pregnancy: when platelets are less than 30 x 109/L, or in preparation for delivery.

• Planned surgery: safe platelet threshold will vary with the nature of the surgery.

• Treatment of ITP in patients with other concurrent risk factors for bleeding (e.g. concurrent anticoagulant therapy).

Chronic ITP: IVIG may be considered as a possible adjunctive therapy as a steroid-sparing measure.

Dose:

Acute: 1 g/kg as a single dose. Repeat if platelet count does not respond. I.e. still less than 30 x 109/L

Chronic: In consultation with a hematologist, as adjunctive therapy or where other therapies have failed or are not appropriate. Consider 1-2 g/kg. The use of regular IVIG as a treatment for chronic ITP should be considered as exceptional and alternative approaches (e.g. splenectomy, rituximab, thrombopoietin receptor agonists) should be considered.