ITP – Treatment of Major Bleed

Clinical practice guideline recommendations for emergency treatment of immune thrombocytopenia:

2019 International Consensus Report practice guidelineA combination of initial treatments, including IV corticosteroids and, usually, IVIG, should be used in emergency situations in which there is an urgent need to increase the platelet count within 24 hours. Platelet transfusions may be helpful and must not be postponed in cases of life-threatening bleeding, especially intracranial hemorrhage.

In the case of life-threatening bleeding and the absence of a significant response to IVIG and platelet transfusion in a patient on corticosteroids, the use of a TPO-RA should be considered.

Additional options may include IV anti-D, vincristine or vinblastine, antifibrinolytics in combination with other initial therapies, and, rarely, emergency splenectomy.
American Society of Hematology (ASH) 2019 guidelineThis guideline specifically focuses on the management of adults and children with ITP and non–life-threatening bleeding.
IVIG, intravenous immune globulin; ITP, immune thrombocytopenia; TPO-RA. thrombopoietin receptor agonist.

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