Recommendations of Stasi and Provan for Emergency Treatment of a Patient wtih Immune Thrombocytopenic Purpura

 

Patient selection: severe bleeding or need for emergency surgery.

 

Basic therapy:

(1) Change and avoid drugs that interfere with platelet function.

(2) Control blood pressure.

(3) Treat with intravenous immunoglobulin (IVIG) at a dose of 1 gram per kg per day for 2 days.

(4) Treat with intravenous methylprednisolone at a dose of 1 gram per day for 3 days.

 

Additional therapy may include:

(1) platelet transfusion at the rate of 1-2 units per hour until an adequate platelet concentration is achieved

(2) aminocaproic acid (Amicar) with 5 grams given IV or po initially and then 1 gram every 5 hours.

(3) splenectomy if unresponsive to all other measures

(4) plasmapheresis for refractory thrombocytopenia