Traditional and new approaches to the management of immune thrombocytopenia: issues of when and who to treat.

Overview

Diagnosis and management of chronic ITP requires experience and the appropriate use of the laboratory despite the absence of a diagnostic test for ITP. Consideration of secondary ITP is important because identification of immunodeficiency infections or of lymphoproliferative disorders would change the management approach to a given patient. The development of newer therapies such as rituximab and the thrombopoietic agents has had a major impact on the management of ITP. In the future, combinations of agents may be a critical approach although the schedule and dosing remains difficult to establish. Finally, current studies to augment therapy in newly diagnosed ITP patients to prevent chronic disease may lessen the number of patients in chronic disease category.