Immune thrombocytopenia (ITP) Adult

Recommended Indications in which IG can be used

Order Number: H8-ITPA

RecommendationsAcute ITP with or at risk for severe bleeding: IVIG is recommended as part of multimodality therapy for patients with ITP, severe thrombocytopenia (platelets less than 30 x 109/L) and severe bleeding.

IVIG may be considered in the following situations:
  • ITP in pregnancy: when platelets are less than 30 x 109/L, or in preparation for delivery.
  • Planned surgery: safe platelet threshold will vary with the nature of the surgery.
  • Treatment of ITP in patients with other concurrent risk factors for bleeding (e.g., concurrent anticoagulant therapy).
Chronic ITP: IVIG may be considered as a possible adjunctive therapy as a steroid-sparing measure.
Dose/Frequency of AdministrationAcute: 1 g/kg as a single dose. Repeat if platelet count does not respond (i.e., still less than 30 x 109/L).

Chronic: In consultation with a hematologist, as adjunctive therapy or where other therapies have failed or are not appropriate. Consider 1-2 g/kg.

The use of regular IVIG as a treatment for chronic ITP should be considered as exceptional and alternative approaches (e.g., splenectomy, rituximab, thrombopoietin receptor agonists) should be considered.