Management of chronic autoimmune thrombocytopenic purpura (ITP) in adults.
The management of thrombocytopenia in adults is a therapeutic challenge requiring not only the science but the art of medicine. The disease is usually chronic and a third of those affected will have significant thrombocytopenia despite attempts at presently accepted forms of management. Adults tolerate moderate degrees of thrombocytopenia and treatment of asymptomatic patients with platelet counts greater than 30 x 10(9)/L is usually not required. Steroids, splenectomy, and the use of steroid-sparing immunosuppressive drugs remain the mainstay of treatment, although short-term responses to intravenous immunoglobulin (IVIg) and anti-D may be beneficial. The multitude of therapies with anecdotal reports of responses attests to the frustration felt by hematologists in the management of this disease when conventional treatments fail.
Garvey
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St Michael's Hospital, Toronto, ON, Canada.
D000305:Adrenal Cortex Hormones / Q000276:immunology; D000328:Adult; D001327:Autoimmune Diseases / Q000209:etiology / Q000276:immunology / Q000628:therapy*; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000150:complications; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D010956:Plasmapheresis; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000209:etiology / Q000276:immunology / Q000628:therapy*; D013156:Splenectomy
D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents