Types of Immune Thrombocytopenia
Immune Thrombocytopenia Treatment, also known as ITP, can be broadly classified into two main types – acute ITP and chronic ITP.
Acute ITP presents suddenly and lasts less than 3 to 6 months. It commonly follows a viral infection or vaccination and the body’s immune system mistakenly destroys its own platelets. Acute ITP is usually seen in children and it resolves on its own in most cases without any treatment.
Chronic ITP persists for more than 6 months. It can develop from an initial acute case that does not resolve or it may present as a chronic condition from the beginning. Chronic ITP is more commonly seen in adults. Unlike acute ITP, chronic ITP may require ongoing treatment to maintain platelet counts and prevent dangerous bleeding.
First Line Immune Thrombocytopenia Treatment Options
The first line treatment given to patients with newly diagnosed ITP depends on their platelet counts and symptoms. For patients with mildly low platelet counts and no bleeding symptoms, a watch-and-wait approach with supportive care may be sufficient.
Corticosteroids like prednisone are often the first treatment tried for patients with symptomatic ITP and platelet counts under 30,000 per microliter. Steroids work to suppress the immune system’s destruction of platelets. Other immunosuppressants like intravenous immunoglobulin (IVIg) or anti-RhD immunoglobulin may also be used for initial therapy.
For pregnant women diagnosed with ITP, treatment aims to maintain platelet counts above 30,000 to minimize risks of bleeding during delivery. Steroids are generally considered the first option. Anti-D immunoglobulin is preferred in RhD-negative patients.
Second Line Treatment Options
For patients who fail or cannot continue first-line treatments, second-line options may include splenectomy or rituximab.
Splenectomy involves surgically removing the spleen, which is a major site of platelet breakdown in ITP. It is an effective treatment for around 70% of chronic ITP patients but risks include infections from asplenia.
Rituximab targets and destroys B cells which produce antibodies that destroy platelets. Success rates of 60-80% have been reported with rituximab use for ITP, making it a commonly used second-line option. Multiple doses are usually required over several months.
Other Options for Refractory Disease
For patients who remain refractory even after splenectomy or rituximab, there are still some other options available though success rates are lower.
Experimental treatments being studied include newer targeted therapies like eltrombopag and romiplostim. These oral drugs work by increasing platelet production from megakaryocytes in the bone marrow.
Bone marrow/stem cell transplantation essentially replaces the faulty immune system but is reserved only for very severe cases due to high risk of transplant-related mortality.
Participation in clinical trials of novel agents can potentially help patients with very difficult to treat disease. Overall management involves weighing the risks and benefits of every Immune Thrombocytopenia Treatment option based on the patient’s age, symptoms and other individual factors.
*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
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