Many ITP patients are asymptomatic and do not require treatment. However, if someone has an increased bleeding tendency and/or their platelet count falls below a certain level, treatment may be necessary. Age and the presence of other conditions may also play a role in the decision to start treatment.
Corticosteroids (prednisone or dexamethasone) and/or immunoglobulins (IVIg) are the first drugs to be prescribed. If they do not work or work insufficiently, Rituximab or TPO receptor agonists can be started.
Rituximab breaks down specific immune cells. As a result, fewer platelets are broken down. Rituximab is administered by infusion once a week, a total of 4 times.
TPO-receptor agonists agonisten
TPO-receptor agonisten zorgen er voor dat het beenberg meer bloedplaatjes aanmaakt.
Romiplostim (N-plate®) 1x per week, injection
Eltrombopag (Revolade®) 1x per day, tablet
Avatrombopag (Doptelet®) 1x per day, tablet
If a particular TPO receptor agonist does not work sufficiently, another TPO receptor agonist may be given.
If the treatments are not sufficiently effective, there are various immunosuppressive drugs that can be used.
A birth control pill can be prescribed for women in order to make menstruation more regular and reduce heavy bleeding problems. Tranexamic acid may also be used to reduce menstrual bleeding.
IVIg and/or corticosteroids are the best choice during pregnancy. Particularly around childbirth, it is necessary to ensure the mother is sufficiently protected against bleeding.
Patients with thrombocytopenia should not take aspirin (acetylsalicylic acid) or NSAIDs (various painkillers) if they have a low platelet count. These drugs limit the function of the remaining platelets and can lead to more bleeding. Acetaminophen does not have this side effect.
In children, observation alone is often sufficient.