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Today I want to talk about the therapies for chronic immune thrombocytopenia (ITP). What are the options, how to sequence them and when is splenectomy recommended?
First things first- the goal platelet count in ITP is 30,000/microliter. That’s it! Yes, you read it right! We’re not aiming for a normal platelet count at all in this disease!
Before we had medications such as eltrombopag, romiplostim or fostamatinib, splenectomy was a commonly performed procedure to treat and potentially cure ITP.
However, splenectomy comes with its own increased risk of infection especially with encapsulated bacteria like pneumococcus and meningococcus and measures must be taken to prevent these by vaccinating against these organisms in anyone who is planned to undergo a splenectomy.
In the era of several medical therapies available to us, I rarely reach for splenectomy upfront. The American Society of Hematology (ASH) 2019 guidelines for immune thrombocytopenia (ITP) recommend thrombopoetin receptor agonists (TPO-RAs) , such as eltrombopag and romiplostim, adults with ITP who have not responded adequately to initial treatments like corticosteroids.
These medications work by stimulating the production of platelets, helping to increase platelet counts and reduce bleeding risks.
Splenectomy is a more invasive procedure and is recommended to be delayed for at least 12 months after diagnosis to allow time for other treatments to be tried and to see if the condition improves on its own. This approach aims to balance the benefits and risks, providing patients with effective treatment options while minimizing potential complications.
Stay tuned for a deeper dive into ITP therapies in the next few posts!
If you’d like to learn more about ITP, check out my post about the diagnosis here
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