Stasi and Provan listed the various factors which affect the decision whether to treat a patient with immune thrombocytopenic purpura (ITP). The authors are from Regina Apostolorum Hospital in Albano Laziale, Italy, St. Bartholomew's Hospital and the Royal London Hospital.

Factors affecting decisions to treat a patient with ITP:

(1) age

(2) level of physical activity (and chance of trauma)

(3) need for surgery

(4) concurrent diseases

(5) concurrent medications

(6) active bleeding

(7) platelet count

(8) possible complications of therapy

(9) patient preferences


A child can tolerate a very low platelet count without excessive bleeding, while an older adult (> 60 years) is more likely to experience significant bleeding.


External Considerations

Minimum Platelet Count

physical occupation

50,000 per µL

athlete in contact sport

80,000 per µL

minor surgery

50,000 per µL

major surgery

80,000 - 100,000 per µL


Diseases that may increase the risk of bleeding:

(1) uremia

(2) poorly controlled hypertension

(3) fever

(4) concurrent infection

(5) alcoholism or chronic liver disease

(6) aneurysm or other vascular disease

(7) malnutrition, especially vitamin K deficiency

(8) peptic ulcer disease or other gastrointestinal bleeding disorder


Concurrent medications:

(1) antiplatelet drugs (aspirin, NSAID, glycoprotein IIb/IIIa inhibitors)

(2) anticoagulants

(3) antibiotics

(4) myelosuppressing agents


Active Bleeding

Platelet Count

Need for Active Therapy





< 10,000 per µL



10,000 - 30,000 per µL

possibly (depending on occupation, drugs, etc)


> 30,000 per µL

usually not (unless at risk for trauma or needs surgery)


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