ITP in adults

Abstract

Most cases of adult ITP are chronic form, and the onset of the disease is usually insidious. Signs and symptoms vary widely in each case from no hemorrhagic symptom to severe life-threatening bleeding, such as intracranial hemorrhage. In addition to hemorrhagic symptom, treatment-related complications, such as infection and cardiovascular diseases, may lead to poor quality of life of ITP patients. Increase of thrombosis in ITP patients is also demonstrated in epidemiologic studies. Once diagnosed with ITP, screening and eradication of H. pylori should be performed in the regions of its high prevalence like Japan. After exclusion of H. pylori-associated ITP, treatment of ITP should be initiated to maintain safe platelet counts as a goal. First-line treatment is corticosteroids and second-line is splenectomy. For refractory ITP patients, thrombopoietin receptor agonists are highly recommended. Rituximab may be another option to get sustained response.