No Treatment

• A fact sheet from the National Heart Lung and Blood Institute states that many case of ITP require no treatment because people with the condition are not currently bleeding or experiencing any symptoms of or complications from ITP. Doctors will begin considering treatment when patients bruise easily, break out in red or purple dots (i.e., bleeding under the skin called petechiae), bleed from their gums or have uncontrollable bleeding following a cut or surgery. Severe untreated ITP can rarely result in fatal internal bleeding.
  
  

Corticosteroids

• Oral or injectable corticosteroids such as prednisone or hydrocortisone constitute the first line of therapy for ITP. Corticosteroids help restore platelet counts by suppressing the action of the immune system. A six-week course of corticosteroids usually suffices to treat ITP initially, but ITP returns in a majority of patients who receive only corticosteroids. Repeated or prolonged courses of corticosteroids need to be considered carefully because, as a Mayo Clinic fact sheet notes, the medications put patients at risk for "cataracts, high blood sugar, increased risk of infections and loss of calcium from ... bones (osteoporosis)."
  
  

Immunoglobulin

• Patients with ITP who need rapid increases in platelet counts may receive intravenous injections of immunoglobulin. Administration of this medication takes several hours, and its effects do not persist for more than a few weeks. The Platelet Disorder Support Association cautions patients that they may feel dizzy, fatigued or nauseated for up to a full day following administration of immunoglobulin. The PDSA also tells patients to seek medical care if they experience breathing problems, convulsions or chest tightness, which can signal an allergic reaction to immunoglobulin.
  
  

Other Medications

• The Mayo Clinic explains that patients with ITP who do not respond well to corticosteroids or who can no longer take those medications may benefit from taking other drugs that increase platelet counts. The rheumatoid arthritis and lymphoma drug rituximab (Rituxan from Genetec and Biogen Idec) suppresses the immune system like corticosteroids do. Medications used to eradicate the stomach ulcer-causing bacterium Helicobacter pylori such as omeprazole plus clarithromycin (e.g., Prilosec from AstraZeneca and Biaxin from Abbott) have also shown some promise for bolstering platelet counts. Each of these alternate medications for treating ITP has its own risks and side effects, so patients need to discuss these options with their doctors.
  
  

Splenectomy

• When all initial drug therapies fail, the next option for ITP treatment is removal of the spleen. The spleen destroys platelets, so removing it via a surgical procedure known as a splenectomy can help patients with ITP maintain their platelet counts. A splenectomy does not guarantee a cure for ITP, however, and it also makes patients who undergo the procedure more susceptible to serious infections.
  
  

Romiplostim and Eltrombopag

• During the later part of 2008, the U.S. Food and Drug Administration approved two new medications specifically for treating ITP in people who continued suffering from the condition despite previous drug treatments and splenectomies. The first of these new approvals, romiplostim (Nplate from Amgen), can only be administered as a subcutaneous injection by doctors enrolled in a special distribution network. Pregnant women should not receive romiplostim injections unless absolutely necessary, and patients who receive too much romiplostim can develop blood clots. The FDA also approved GlaxosmithKline's eltrombopag (Promacta) for treating nonresponsive ITP. The tablets can cause liver damage and, like romiplostim, cause blood clots when taken in excessive doses.
  
  

Platelet Transfusions

• Patients with ITP may receive transfusions of platelets in addition to their current treatment if they are bleeding heavily. The increase in platelet counts following a transfusion lasts only a few hours to a couple of days.