AND OTHER PLATELET DISORDERS
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There are many treatments for ITP. All treatment options have different risks and benefits, and some can be toxic causing serious side effects. It is important to understand both the success rate and potential side effects before beginning a treatment.
The general types of conventional treatments include:
An ITP diagnosis and the low platelet count it causes are sometimes associated with a bacterial infection—and antibiotics used to fight the infection have been shown to raise platelet counts. There has been considerable research on the success of antibiotics used to treat the H. pylori (helicobacter pylori) bacteria infection in those diagnosed with ITP. The treatment and eradication of other infections can also help raise the platelet count.
Anti-RhoD (WinRho®) is an intravenous (IV) drug infusion used to elevate platelet counts temporarily, and can be repeated over a period of time for extended relief. Often used as a “first line” therapy, the shorter infusion time and often lower cost of Anti-RhoD can offer an advantage over intravenous immunoglobulin (IVIG) for some patients.
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B-cell depletion by a monoclonal antibody (anti-CD20, rituximab [Rituxan®]) is a widely used treatment choice, but has not been approved by the Food and Drug Administration (FDA) to treat ITP. B-cell depletion works by disabling and changing B-cells, a type of white blood cell.
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Various chemotherapy drugs, including vincristine (Oncovin®) and cyclophosphamide (Cytoxan®) have been used as a second or third-line treatment choice for chronic ITP patients. Each has a slightly different side effect profile. While they have been effective in a small percentage of cases, chemotherapy drugs can be quite toxic and have not been approved by the FDA to treat ITP.
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Many doctors consider corticosteroids (steroids) for their initial approach for newly diagnosed patients. While corticosteroids (prednisone or dexamethasone) are a commonly used “front line” therapy and have been shown to increase the platelet count while being taken, the FDA has not approved them for the treatment of ITP. The type, dose and duration depend on the patient's particular condition and tolerance.
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Immunosuppressants, including azathioprine (Imuran®), cyclosporine (Sandimmune®), diphenylsulfone (Dapsone®), Sirolimus (Rapamycin®), and mycophenolate mofetil (Cellcept®), are considered a second or third-line treatment for ITP. This class of drugs is used to treat other autoimmune diseases, including multiple sclerosis (MS) and lupus, but none have gained FDA approval to treat ITP.
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BTK inhibitor rilzabrutinib (WAYRILZ™) is approved by the Food and Drug Administration (FDA) for adults with persistent or chronic immune thrombocytopenia (ITP) who have received a prior treatment that did not work well enough.
Intravenous immunoglobulin (IVIG) is a type of antibody treatment used as a “front line” therapy to temporarily elevate platelet counts. Although IVIG is not expected to result in a sustained, elevated platelet count, in rare cases this does occur and the drug can be repeated for longer lasting results. IVIG is manufactured by several companies, some of which have received FDA approval for its use in the treatment of ITP.
The synthetic androgen (male sex hormone) danazol (Danocrine®) is sometimes used to treat ITP when other treatments have failed. Danazol is considered a second-line treatment, used after other treatments are considered or fail.
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A new approach to treating ITP is the use of a spleen tyrosine kinase (SYK) inhibitor. The agent fostamatinib disodium hexahydrate (TAVALISSE™) may slow the destruction of antibody-coated platelets in people with chronic ITP by specifically targeting SYK. Spleen tyrosine kinase (SYK) is part of a network of proteins (found in certain cells of the immune system) that triggers platelet destruction.
Second-line ITP treatment approach using platelet growth factors or thrombopoietin (TPO) receptor agonists. These agents, avatrombopag (Doptelet®), eltrombopag (Promacta®/Revolade®), and romiplostim (Nplate®), stimulate the bone marrow to produce more platelets. Once thought to be only a disease of platelet destruction, research advances have shown that many people with ITP also have a platelet production problem which is believed to be caused by the same antibodies and cells that attack the platelets.
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This is a surgical procedure to remove the spleen. The spleen is a large blood filter, which for many people removes antibody-coated platelets. Theoretically, if the spleen is removed, the platelets will remain in circulation. However, there are other ways the body removes platelets, so this treatment sometimes fails to have a lasting effect.
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More of a strategy than a treatment, ‘Watchful Waiting’ means choosing to live with you or your child's current platelet counts while carefully monitoring the disease and treatment options.
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Treatment information does not represent an endorsement by PDSA or its medical advisors. For advice on your unique medical condition, please consult your healthcare provider.
For those with ITP, the primary focus is on feeling better. While numerous conventional treatment options may be recommended for the bleeding disorder—and new medications continue to be developed—many look to complementary medicine approaches to help manage symptoms and enhance their quality of life.
Relied on for thousands of years by those in pursuit of health and well being, complementary therapies are used today by about 40 percent of adults in the United States and they continue to grow in popularity. In fact, many doctors often incorporate an “integrative medicine” approach, combining complementary therapies with mainstream medical treatments for additional relief.
Unfortunately, there is very little scientific research on the use of complementary therapies, specifically for ITP. And, while some people have found these alternative approaches have helped, they also come with their own risks. To help understand complementary therapies, you should ask your doctor the same questions as any other treatment to understand the best approach for your condition.
There are many complementary therapies available and the options constantly change as treatments undergo testing. The National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health (NIH) classifications of types of complementary health approaches used to treat a variety of conditions include:
(Information regarding complementary medicine therapies does not represent an endorsement by PDSA or its medical advisors. For advice on your unique medical condition, please consult your healthcare provider.)
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IMPORTANT!
The Platelet Disorder Support Association does not provide medical advice or endorse any medication, vitamins or herbs. The information contained herein is not intended nor implied to be a substitute for professional medical advice and is provided for educational purposes only. Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment, discontinuing an existing treatment and to discuss any questions you may have regarding your unique medical condition.
