The most common causes of death in patients with ITP:
(1) intracranial hemorrhage associated with severe thrombocytopenia
(2) following splenectomy
(3) opportunistic infection after aggressive immunosuppressive therapy
Risk factors:
(1) older age (> 60 years of age)
(2) chronic course refractory to standard therapies
(3) history of significant bleeding
(4) concomitant bleeding disorder (uremia, hemophilia, other)
(5) structural lesion in CNS or GI tract
Recommendations:
(1) Avoid aggressive immunosuppressive therapy unless clearly indicated. A patient with a platelet count > 20,000 per µL rarely needs immunosuppressive therapy.
(2) In a patient with suspected intracranial hemorrhage platelets should be transfused immediately upon sign of neurologic deterioration. This may help reduce the risk of permanent neurologic sequelae.
(3) Patients should avoid aspirin or other agents that interfere with platelet function.
(4) Aggressive management (emergency splenectomy, plasmapheresis, vinca alkaloids) may be indicated in children with progressive symptoms despite standard therapy with steroids and immune globulins.
