Annals of Hematology

, Volume 89, Supplement 1, pp 61–65 | Cite as

Chronic immune thrombocytopenic purpura—who needs medication?

  • Paula H. B. Bolton-MaggsEmail author
  • Victoria S. L. Kok
Chronic ITP


Chronic ITP (immune thrombocytopenic purpura; now defined as duration of more than 12 months) is not always associated with significant bleeding problems so that most children and adults can be managed expectantly with no medication unless surgery, accidents or other pathology mandate it. A cut-off platelet count of 30 × 109/l divides a group with no increased mortality from those whose risk is greater and in whom medication is usually appropriate. There is increasing recognition of long-term morbidity and mortality associated with immune suppression induced by medication and more recently new concerns have arisen about the long-term vascular complications of splenectomy. A more conservative approach to medication is warranted in many patients with chronic ITP.


Chronic ITP Immune thrombocytopenia Immune modulation Splenectomy 


  1. 1.
    Blanchette V, Bolton-Maggs P (2008) Childhood immune thrombocytopenic purpura: diagnosis and management. Pediatr Clin North Am 55(2):393–420CrossRefPubMedGoogle Scholar
  2. 2.
    Bolton-Maggs P (2009) Acute immune thrombocytopenic purpura. To treat or not to treat? Hamostaseologie 29(1):74–75PubMedGoogle Scholar
  3. 3.
    Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM et al (2009) Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 113(11):2386–2393CrossRefPubMedGoogle Scholar
  4. 4.
    De Mattia D, Del Vecchio GC, Russo G, De Santis A, Ramenghi U, Norarangelo L, Jankovic M, Molinari AC, Zecca M, Nobilib B, Giordano P (2009) Management of chronic childhood immune thrombocytopenic purpura: AIEOP consensus guidelines. Acta Haematol 123:96–109CrossRefPubMedGoogle Scholar
  5. 5.
    Tamminga R, Berchtold W, Bruin M, Buchanan GR, Kuhne T (2009) Possible lower rate of chronic ITP after IVIG for acute childhood ITP an analysis from registry I of the intercontinental cooperative ITP study group (ICIS). Br J Haematol 146:180–184CrossRefPubMedGoogle Scholar
  6. 6.
    Mazzucconi MG, Fazi P, Bernasconi S, De Rossi G, Leone G, Gugliotta L et al (2007) Therapy with high-dose dexamethasone (HD-DXM) in previously untreated patients affected by idiopathic thrombocytopenic purpura: a GIMEMA experience. Blood 109(4):1401–1407CrossRefPubMedGoogle Scholar
  7. 7.
    Kojouri K, Vesely SK, Terrell DR, George JN (2004) Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications. Blood 104(9):2623–2634CrossRefPubMedGoogle Scholar
  8. 8.
    Schilling RF, Gangnon RE, Traver MI (2008) Delayed adverse vascular events after splenectomy in hereditary spherocytosis. J Thromb Haemost 6(8):1289–1295CrossRefPubMedGoogle Scholar
  9. 9.
    Cheng G, Gernsheimer T, Olney HJ, Bussel JB, Sha P, Brainsky A, Grotzinger KM, Aivado M (2009) Time to splenectomy failure in patients with recurrent or refractory chronic immune thrombocytopenic purpura. Blood abstract from the 2009 ASH conference accessed online (28 January 2010) at Scholar
  10. 10.
    Vianelli N, Valdre L, Fiacchini M, de Vivo A, Gugliotta L, Catani L et al (2001) Long-term follow-up of idiopathic thrombocytopenic purpura in 310 patients. Haematologica 86:504–509PubMedGoogle Scholar
  11. 11.
    Portielje JE, Westendorp RG, Kluin-Nelemans HC, Brand A (2001) Morbidity and mortality in adults with idiopathic thrombocytopenic purpura. Blood 97:2549–2554CrossRefPubMedGoogle Scholar
  12. 12.
    Cohen YC, Djulbegovic B, Shamai-Lubovitz O, Mozes B (2000) The bleeding risk and natural history of idiopathic thrombocytopenic purpura in patients with persistent low platelet counts. Arch Intern Med 160:1630–1638CrossRefPubMedGoogle Scholar
  13. 13.
    Bourgeois E, Caulier MT, Delarozee C, Brouillard M, Bauters F, Fenaux P (2003) Long-term follow-up of chronic autoimmune thrombocytopenic purpura refractory to splenectomy: a prospective analysis. Br J Haematol 120:1079–1088CrossRefPubMedGoogle Scholar
  14. 14.
    Neylon AJ, Saunders PW, Howard MR, Proctor SJ, Taylor PR (2003) Clinically significant newly presenting autoimmune thrombocytopenic purpura in adults: a prospective study of a population-based cohort of 245 patients. Br J Haematol 122:966–974CrossRefPubMedGoogle Scholar
  15. 15.
    Fogarty PF (2009) Chronic Immune thrombocytopenia in adults: epidemiology and clinical presentation. Hematol Oncol Clin North Am 23:1213–1221CrossRefPubMedGoogle Scholar
  16. 16.
    BCSH (2003) Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Br J Haematol 120:574–596CrossRefGoogle Scholar
  17. 17.
    Bolton-Maggs PH, Moon I (1997) Assessment of UK practice for management of acute childhood idiopathic thrombocytopenic purpura against published guidelines. Lancet 350(9078):620–623CrossRefPubMedGoogle Scholar
  18. 18.
    Bussel JB, Cheng G, Saleh MN, Psaila B, Kovaleva L, Meddeb B et al (2007) Eltrombopag for the treatment of chronic idiopathic thrombocytopenic purpura. N Engl J Med 357:2237–2247CrossRefPubMedGoogle Scholar
  19. 19.
    Kuter DJ, Bussel JB, Lyons RM, Pullarkat V, Gernsheimer TB, Senecal FM et al (2008) Efficacy of romiplostim in patients with chronic immune thrombocytopenic purpura: a double-blind randomised controlled trial. Lancet 371(9610):395–403CrossRefPubMedGoogle Scholar
  20. 20.
    Beck CE, Nathan PC, Parkin PC, Blanchette VS, Macarthur C (2005) Corticosteroids versus intravenous immune globulin for the treatment of acute immune thrombocytopenic purpura in children: a systematic review and meta-analysis of randomized controlled trials. J Pediatr 147:521–527CrossRefPubMedGoogle Scholar
  21. 21.
    Guidry JA, George JN, Vesely SK, Kennison SM, Terrell DR (2009) Corticosteroid side-effects and risk for bleeding in immune thrombocytopenic purpura: patient and hematologist perspectives. Eur J Haematol 83:175–182CrossRefPubMedGoogle Scholar
  22. 22.
    Compston J (2004) US and UK guidelines for glucocorticoid-induced osteoporosis: similarities and differences. Curr Rheumatol Rep 6:66–69CrossRefPubMedGoogle Scholar
  23. 23.
    Bone and Tooth Society of Great Britain, National Osteoporosis Society and Royal College of Physicians (2002) Glucocorticoid-induced osteoporosis. Guidelines for prevention and treatment. London: RCP, ISBN 1 86016 173 1Google Scholar
  24. 24.
    Carson KR, Evens AM, Richey EA, Habermann TM, Focosi D, Seymour JF et al (2009) Progressive multifocal leukoencephalopathy following rituximab therapy in HIV negative patients: a report of 57 cases from the Research on Adverse Drug Event and Reports (RADAR) project. Blood 113:4834–4840CrossRefPubMedGoogle Scholar
  25. 25.
    Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussell JB et al (2010) International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 115:168–186CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Paula H. B. Bolton-Maggs
    • 1
    Email author
  • Victoria S. L. Kok
    • 1
  1. 1.Department of Clinical HaematologyCentral Manchester and Manchester Children’s University NHS Foundation Trust, Manchester Royal InfirmaryManchesterUK

Personalised recommendations