Immune thrombocytopenic purpura: the treatment paradigm

Immune (idiopathic) thrombocytopenic purpura (ITP) is a heterogeneous disease with highly variable severity and an unpredictable response to therapy. This heterogeneity presents a range of problems to the clinician when deciding who should receive pharmacological treatment and when such interventions should be initiated. Treatment guidelines are available but, given the current small amount of data from research and randomized, controlled trials, the guidelines are largely based on expert opinion rather than on evidence. At the moment, it is only recommended that those patients with severe bleeding and/or extremely low platelet counts (< 10 x 10(9)/L) definitely require treatment. In all other patients the decision to treat must be made based on a careful evaluation of disease severity, patient characteristics, and the possibility of treatment-related adverse events. This article describes a structured approach to the management of adults with ITP.