Immune Thrombocytopenia (ITP)
Description General Measures Medicine Treatment Referral D69.3 DESCRIPTION A common bleeding disorder due to immune-mediated destruction of platelets. Clinically apparent associated conditions, drugs (e.g. penicillins, cephalosporins, quinine, rifampicin and heparin), or other agents that may cause thrombocytopenia must be excluded before a diagnosis of ITP can be considered. Patients with suspec
D69.3
DESCRIPTION
A common bleeding disorder due to immune-mediated destruction of platelets.
Clinically apparent associated conditions, drugs (e.g. penicillins, cephalosporins, quinine, rifampicin and heparin), or other agents that may cause thrombocytopenia must be excluded before a diagnosis of ITP can be considered. Patients with suspected ITP should be tested for SLE and for HIV infection.
Investigations
- Thrombocytopenia with normal white cell count and red cell indices (however, anaemia may be present due to blood loss).
- Peripheral blood smear to exclude RBC fragments. Smear may show large platelets.
- Do INR and aPTT, both of which should be normal in ITP.
- If there is poor response to treatment, to do a bone marrow aspirate and biopsy.
GENERAL MEASURES
- Avoid:
- medication that affects platelet function, e.g. NSAIDs and aspirin,
- platelet transfusions, unless there are life-threatening bleeds,
- unnecessary treatment of asymptomatic patients with mild to moderate thrombocytopenia (platelet count >30 x 109 /L).
- dental procedures in acute phase, and
- intramuscular injections.
- Reassure the patient that resolution usually occurs in acute ITP.
- Medic alert bracelet.
- Platelet transfusions may be given if surgery is required or in life-threatening bleeding: discuss with haematologist.
- Goal of treatment is to reduce the risk of bleeding rather than to normalise the platelet count.
MEDICINE TREATMENT
Acute ITP
- Prednisone, oral, 1 mg/kg daily, until platelet count has normalised.
- Taper slowly and monitor platelet count. (Refer to Appendix II: Prescribing Information for Specific Medicines, for an example of a dose reduction regimen).
- Although prednisone is also indicated for HIV-associated immune thrombocytopenia, it is important that these patients should be fast-tracked for antiretroviral therapy (ART) – See: Antiretroviral therapy.
LoE:IIbxxii
Acute life-threatening bleeding and surgery
- Platelet transfusion, intravenous, 1 unit immediately.
- Platelet transfusions are only indicated in acute active bleeding uncontrolled by other means or before procedures.
- In an adult, 1 unit of platelets (preferably single donor, leucocyte depleted) is usually sufficient to control the bleeding initially.
- Platelet transfusions have limited benefit in this condition as platelets are rapidly destroyed by the immune system.
- Methylprednisolone succinate 1 g, IV, daily for 3 days.
LoE:IIIbxxiii
REFERRAL
- All cases not responding to steroids that require second line treatment - Consult haematologist.
- All PLHIV who are not responding to ART - Consult haematologist
Standard Treatment Guidelines And Essential Medicines List For South Africa, Adult Hospital level_Version 1_30 March 2026
Chapter 2: Blood and Blood Forming Organs; 2.5 Immune Thrombocytopenia (ITP)