Therapeutic ManagementManagement of

Therapeutic Management
Management of ITP is primarily supportive, since the course of the disease is self-limited in the majority of cases. Activity is restricted at the onset while the platelet count is low and while active bleeding or progression of lesions is occurring. Treatment for acute presentation is symptomatic and has included prednisone, IV immune globulin (IVIG), and anti-D antibody. These are not curative therapies. Anti-D antibody is a relatively new therapy for ITP. Infusion of anti-D antibody causes a transient hemolytic anemia in the patient. Along with the clearance of antibody-coated RBCs, there is prolonged survival of platelets resulting from the blockade of the Fc receptors of the reticuloendothelial cell. The platelet count does not increase until 48 hours after an infusion of anti-D antibody; therefore it is not appropriate therapy for patients who are actively bleeding. The benefits of choosing anti-D antibody therapy over prednisone or IVIG is that anti-D antibody can be given in one dose over 5 to 10 minutes and is significantly less expensive than IVIG. Historically, patients who are treated with prednisone may first undergo a bone marrow examination to rule out leukemia. Therefore the use of anti-D antibody alleviates the need for a bone marrow examination. Patients must meet certain criteria before the administration of anti-D antibody (Box 26-7). Premedication with acetaminophen 5 to 10 minutes before infusion is recommended.