The classic therapies of ITP are corticosteroids and splenectomy. These therapies will suffice to treat the majority of patients. In any patient with ITP in whom an urgent rise in the platelet count is required, especially children with acute ITP at diagnosis, gammaglobulin in combination with corticosteroids is very effective. In children with persistent ITP, avoiding splenectomy by using IVGG maintenance has been shown to be an effective form of therapy. For adults, most patients will be adequately treated by a short course of steroids followed by splenectomy, if needed. Other treatments are most needed in those adults whose ITP fails to respond to splenectomy or those who have special conditions. Danazol, vinca alkaloids, oral cyclophosphamide, and IVGG appear to be effective as chronic maintenance therapies, especially of splenectomized patients who are still thrombocytopenic. The role of newer therapies such as staph protein A pheresis and intravenous anti-D remains to be more completely explored.
