Isolated ↓platelets, mucocutaneous bleeding; diagnosis of exclusion
Asymptomatic >30k → observe
Treat: Dexamethasone 40 mg PO ×4 d PREFERRED (ASH 2019); or prednisone 1 mg/kg, ≤6–8 wk max including taper (↓ macrophage affinity for platelets)
Active bleeding / very low → IVIG 1 g/kg (works fastest)
Chronic → TPO receptor agonists (eltrombopag/romiplostim) generally preferred before splenectomy; rituximab; defer splenectomy ≥1 year from diagnosis (ASH 2019)
Order set
- FBC, film
- Exclude pseudothrombocytopenia
- HIV/HCV/H. pylori screen
Criteria
AdmitBleeding or platelets very low
ICUMajor/intracranial bleeding
TransfusePlatelets only for life-threatening bleeding + IVIG/steroids
DischargePlatelets safe, bleeding stopped, on therapy + follow-up
Clinical detail — differentials, red flags, pitfalls, disposition
Red flags
- Mucosal/intracranial bleeding
- Platelets <10–20k
Differentials
- TTP/HUS
- Drug-induced
- Marrow failure
- DIC
Common mistakes
- Missing secondary causes
- Over-treating asymptomatic mild ITP
Disposition & follow-up
Steroids/IVIG per severity; haematology follow-up.
Discharge package
MedicationsSteroid taper ± second-line
Follow-upHaematology; platelet monitoring
Warning symptomsNew bruising, mucosal/heavy bleeding, headache
💊 Treatment detail — doses & preparation
Prednisone (ITP/AIHA)corticosteroid
Dose1 mg/kg OD until platelets/Hb recover, then slow taper over weeks
PreparationTablets with food
MonitorGlucose, BP, mood; bone + gastric protection if prolonged
IVIGimmunoglobulin
Dose1 g/kg/day ×2 d (ITP bleeding, GBS total 2 g/kg over 2–5 d)
Preparation50/100 mL ready bottles; start slow (30 mL/h), escalate per tolerance
MonitorHeadache/aseptic meningitis, renal function, thrombosis; live vaccines after
Tranexamic acidantifibrinolytic
Dose1 g IV/PO TDS (bleeding in VWD/haemophilia adjunct, menorrhagia)
Preparation500 mg tablets; IV 1 g in 50 mL NS over 10 min
MonitorAvoid with PCC/combined hormonal contraception (thrombosis); haematuria caution (clot colic)
Thrombopoietin agonistsecond-line
DoseEltrombopag 50 mg OD (romiplostim SC weekly alternative) for chronic ITP
PreparationTablets on empty stomach (chelates with Ca²⁺/dairy)
MonitorPlatelets weekly during titration; LFTs
📖 ASH / BSH ITPReviewed July 2026