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Diagnosis of ITP Remains a Challenge for Clinicians

Angelica Welch
Published: Thursday, Sep 20, 2018

Ronald S. Go, MD

Ronald S. Go, MD

Idiopathic thrombocytopenic purpura (ITP) is a disorder that can present as bruising or mucosal bleeding, but is usually diagnosed through a process of elimination, explained Ronald S. Go, MD.

Go, an associate professor of medicine at Mayo Clinic, discussed the current treatment strategies of patients with ITP, as well as the process that some physicians use to determine whether a patient is suffering from the disorder.

OncLive: Could you begin by discussing the presentation of ITP?

Go: The presentation is isolated thrombocytopenia. Of course, patients do not generally come to doctors because they know their platelet counts are low. Mucosal bleeding symptoms and bruising are the initial presentations of ITP. Patients will then have a complete blood count done to look for isolated thrombocytopenia. If there are other cytopenias, anemia, or leukopenia, then we have to look for other possible causes of bicytopenia or pancytopenia. Most often, ITP is [characterized] by low platelets. 

We then look at the history to make sure there is nothing else causing the low platelets, such as medications, comorbidities like liver disease, or conditions associated with hypersplenism, all of which can cause thrombocytopenia. 

What is the current treatment for these patients?

The first question is, “Who needs treatment?” Generally speaking, it is for those who have platelet counts below 30,000, according to the ASH guidelines. Unless your patient is above 30,000 and is actively bleeding or has symptoms, then we do not treat—we watch. As far as treatment is concerned, most of the time the first-line of treatment is prednisone if there is no contraindication. That works for about 80% of the patients. The platelets will improve, and then we taper them over a couple of weeks. In some patients, that may be the end of it, but in some patients there may be a relapse.
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