Treatment of immune thrombocytopenic purpura in adults

Idiopathic thrombocytopenic purpura (ITP) is a hematologic disorder characterized by the destruction of antibody-coated platelets in the reticuloendothelial system. Whereas 70% to 80% of children experience the acute form of the disease and recover within a few weeks or months after diagnosis, most adults have persistent disease and will require therapy. Principles of management are largely predicated on the extent of thrombocytopenia and symptoms of disease. Minimizing the toxicity associated with treatment while achieving hemostatic platelet counts are essential goals of treatment. Although there are numerous therapeutic options, neither consensus among experts nor clear algorithms to treat this complex disease exist. This article will review appropriate treatment options available for adult patients with ITP prior to splenectomy, at splenectomy, and following splenectomy. In addition to conventional agents such as corticosteroids and intravenous immune globulin (IVIg), the role of newer therapies with diverse mechanisms of action, such as rituximab, anti-D, and thrombopoietin (TPO)-like agents, will be highlighted. When used as either monotherapy or in combination with conventional therapeutics, these treatments may offer a more tolerable side effect profile and improved clinical benefit compared to existing drugs.