Stasi and Provan recommended a number of interventions for a patient with immune thrombocytopenic purpura (ITP) and severe hemorrhage. The authors are from Regina Apostolorum Hospital in Albano Laziale, Italy, St. Bartholomew's Hospital and the Royal London Hospital.


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


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