Clinical management of adult ITP prior to splenectomy: a perspective

A philosophy of management of adult immune thrombocytopenic purpura (ITP) prior to splenectomy is presented. The initial action is to determine whether the condition is hyperacute, acute, or chronic. In symptomatic cases, initial remission usually requires steroids and the administration of intravenous immunoglobulin (i.v.Ig), followed by platelet transfusion if the patient is actively hemorrhaging. Once initial remission is achieved, a rapid reduction to minimal maintenance therapy should be made. The options include steroids, immunotherapy, and chemotherapy. Adjustments to maintenance therapy must be made with the understanding that response rates vary for each agent.