Immune Thrombocytopenic Purpura (ITP)MANAGEMENT

HEMATOLOGIC AND ONCOLOGIC PRESENTATIONS · 12 SECTIONS

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532 items

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Cardiovascular Presentations71▾

Respiratory Presentations52▾

Neurological Presentations83▾

Gastrointestinal Presentations74▾

Genitourinary and Reproductive Presentations48▾

Infectious Disease Presentations148▾

Trauma Presentations89▾

Toxicologic Presentations80▾

Psychiatric Presentations26▾

Musculoskeletal and Rheumatologic Presentations96▾

Dermatology Presentations23▾

Environmental and Exposure Presentations27▾

Hematologic and Oncologic Presentations36▾

Acute chest syndrome Acute Hemolytic Transfusion Reaction Anticoagulant reversal (warfarin, DOAC, heparin)Aplastic Anemia (Crisis)Autoimmune Hemolytic Anemia CAR-T and cytokine release syndrome Coagulopathy Delayed Hemolytic Transfusion Reaction Disseminated Intravascular Coagulation (DIC)Essential Thrombocythemia Febrile Non-hemolytic Transfusion Reaction Graft Versus Host Disease (Acute)Hemolytic Uremic Syndrome (HUS)Hemophilia A (Bleeding Crisis)Heparin-Induced Thrombocytopenia (HIT)Hyperviscosity syndrome Immune checkpoint inhibitor toxicity Immune Thrombocytopenic Purpura (ITP)Leukemoid Reaction Leukostasis Massive transfusion protocol Myelofibrosis Neutropenic enterocolitis (typhlitis)Paroxysmal Nocturnal Hemoglobinuria Polycythemia Vera (Crisis)Pure Red Cell Aplasia Sickle Cell (Acute Chest Syndrome)Sickle Cell (Splenic Sequestration)Sickle cell crisis (vaso-occlusive)Symptomatic anemia Thrombocytopenia (severe)Thrombotic Thrombocytopenic Purpura (TTP)Transfusion-Associated Circulatory Overload (TACO)Transfusion-Related Acute Lung Injury (TRALI)Tumor lysis syndrome Von Willebrand Disease (Bleeding)

Pediatric-Specific Presentations19▾

Endocrine and Metabolic Presentations45▾

ENT and Maxillofacial Presentations27▾

Ophthalmologic Presentations19▾

Obstetric Presentations23▾

Systemic and Miscellaneous Presentations17▾

01Approach to the Critical Patient/attcp39

Hemorrhagic emergency recognition

›Critical bleed triggers

›Intracranial hemorrhage presentation

›Severe headache with thrombocytopenia

›Altered mental status or focal neurologic deficits

›Immediate CT head and hematology/neurosurgery activation

›Life-threatening mucosal or visceral bleeding

›Hematemesis, melena, or hematochezia with hemodynamic compromise

›Hematuria with clots

›Platelet count <10 x 10³/μL as independent trigger

›Wet purpura as escalation signal

›Oral hemorrhagic bullae indicating severe mucosal bleeding risk

›Admission regardless of platelet count when wet purpura present

Immediate resuscitation priorities

›Hemodynamic stabilization

›SBP target >90 mmHg

›MAP target >65 mmHg

›Two large-bore IV access

›Fluid resuscitation for hemodynamic instability

›Airway management

›Protect airway in obtunded patients with active oropharyngeal bleeding

›Intubation preparation if airway threatened by hemorrhage

›Emergency pharmacotherapy for critical bleed

›Platelet transfusion 1–2 units (transient; use with other agents)

›Methylprednisolone 1 g IV or dexamethasone 40 mg IV

›IVIG 1 g/kg IV day 1; repeat day 2 if needed

›Tranexamic acid 1 g IV or 1.3 g PO TID

›TPO-receptor agonist initiation (romiplostim or eltrombopag)

02History/hx46

Bleeding symptom characterization

›Mucocutaneous bleeding pattern

›Petechiae onset and distribution

›Purpura and ecchymoses

›Epistaxis frequency and duration

›Gum bleeding

›Menorrhagia (volume, pad count, clots)

›Hematuria

›GI bleeding (hematemesis, melena, hematochezia)

Onset and temporal pattern

›Acuity of presentation

›Acute sudden onset (more common in children, often post-viral)

›Gradual insidious onset (typical adult chronic pattern)

›Duration of symptoms before presentation

›Previous episodes of thrombocytopenia or ITP (relapse vs. chronic)

›Prior CBC results for baseline comparison

Precipitating and contextual factors

›Preceding illness or triggers

›Recent viral URI (especially in children)

›Vaccination history within 4–6 weeks (MMR, varicella, COVID-19, influenza)

›Recent infection (HIV, HCV, HBV, H. pylori exposure risk)

›Medication review

›New medications within 3–10 days before thrombocytopenia onset

›Quinine or quinidine

›Carbamazepine, rifampicin, vancomycin, TMP-SMX

›Abciximab or heparin

›OTC drugs, herbals, alcohol, supplements

›Anticoagulant or antiplatelet use

03Physical Exam/exam38

Vital signs and hemodynamic assessment

›Stability indicators

›Blood pressure

›SBP <90 mmHg or MAP <65 mmHg indicating active hemorrhage

›Orthostatic changes suggesting volume depletion

›Heart rate

›Tachycardia as hemorrhage marker

›Temperature

›Fever suggesting infection, TTP, or secondary ITP

Skin and mucocutaneous exam

›Bleeding sign characterization

›Petechiae (dependent areas, pressure points, lower extremities)

›Distribution and extent

›Fresh vs. resolving lesions

›Purpura and ecchymoses

›Size and number

›Age of lesions

›Wet purpura

›Hemorrhagic bullae on buccal mucosa

›Marker of higher serious bleeding risk

›Gum bleeding on oral inspection

Focused systemic exam

›Lymph node assessment

›Lymphadenopathy atypical for primary ITP

›If present, suggests lymphoproliferative disorder, infection, or SLE

›Abdominal exam

›Splenomegaly

›Spleen NOT typically enlarged in primary ITP

04Differential Diagnosis/ddx38

Life-threatening cannot-miss diagnoses

›Thrombotic thrombocytopenic purpura (TTP)

›ICD-10: M31.1

›Neurologic symptoms, MAHA with schistocytes on smear

›Elevated LDH, low ADAMTS13 (<10%)

›Fever, renal dysfunction (pentad)

›Hemolytic uremic syndrome (HUS)

›ICD-10: D59.3

›Renal failure predominant, MAHA

›Shiga toxin-associated (diarrhea prodrome)

›Disseminated intravascular coagulation (DIC)

›ICD-10: D65

›Elevated PT/INR and PTT, low fibrinogen, elevated D-dimer

›Underlying trigger (sepsis, malignancy, obstetric emergency)

›Heparin-induced thrombocytopenia (HIT)

›ICD-10: D75.82

›Thrombosis plus heparin exposure

›4T score for risk stratification

›Acute leukemia or myelodysplastic syndrome

›ICD-10: C91–C95, D46

›Other cytopenias, blasts or dysplastic cells on smear

Common mimics

›Pseudothrombocytopenia

›EDTA-induced platelet clumping

›Repeat CBC in citrate or heparin tube to confirm

›Drug-induced immune thrombocytopenia

›ICD-10: D69.59

›Resolves 7–10 days after drug withdrawal

05Laboratory Tests/lt43

Initial essential workup

›Complete blood count with differential

›Isolated thrombocytopenia; other cell lines normal in primary ITP

›Platelet count <100 x 10³/μL required for ITP diagnosis

›Anemia or leukopenia suggests secondary cause

›Peripheral blood smear

›Reduced platelets, may show large (reticulated) platelets

›No schistocytes (excludes TTP/HUS)

›No blasts or dysplastic changes (excludes leukemia/MDS)

›Essential for all new thrombocytopenia presentations

›Reticulocyte count

›Normal in isolated ITP

›Elevated suggests concurrent hemolysis

›Coagulation studies

›PT/INR, PTT, fibrinogen

›Normal in ITP; abnormal PT/PTT or low fibrinogen suggests DIC

Secondary cause exclusion panel

›Hemolysis panel

›LDH, haptoglobin, indirect bilirubin, DAT (Coombs test)

›Elevated LDH + schistocytes triggers TTP protocol

›Positive DAT with anemia suggests Evans syndrome

›Infectious serologies

›HIV antibody/antigen testing

›Hepatitis B surface antigen, HBsAb, HBcAb

›Hepatitis C antibody and viral load if seropositive

›H. pylori testing

›Stool antigen or urea breath test (preferred non-invasive methods)

›Eradication can improve platelet count in H. pylori-positive ITP

06Diagnostic Tests/dt49

Scoring Systems

›ITP bleeding severity assessment

›WHO Bleeding Scale

›Grade 0: No bleeding

›Grade 1: Petechiae only

›Grade 2: Mild blood loss

›Grade 3: Gross blood loss requiring transfusion

›Grade 4: Debilitating blood loss (ICH, retinal, or life-threatening)

›ITP-specific bleeding score (ITP-BAT)

›Validated tool for quantifying bleeding in skin, mucosa, and organs

›Used in clinical trials and specialist follow-up

›HIT probability scoring

›4T Score for heparin-exposed patients

›Low (0–3): <1% probability of HIT

›Intermediate (4–5): ~10% probability

›High (6–8): ~50% probability

›Triggers anti-PF4 antibody testing

MRI

›Intracranial hemorrhage evaluation

›MRI brain with gradient echo or susceptibility-weighted imaging

›Higher sensitivity than CT for small or subacute hemorrhagic foci

›Preferred when CT negative but clinical suspicion remains high

›MRI indications in ITP

›Persistent headache with normal CT

›Subacute neurologic symptoms

›Evaluation of intraparenchymal vs. subdural vs. subarachnoid extension

›MRI spine

›Epidural hematoma concern with back pain and neurologic deficit

07Disposition/dispo25

Admission criteria

›Inpatient admission indications

›Platelet count <20 x 10³/μL in newly diagnosed ITP (ASH 2019 guideline)

›Even if asymptomatic or with minor mucocutaneous bleeding

›Active significant bleeding at any platelet count

›Suspected intracranial, retroperitoneal, or visceral hemorrhage

›Diagnostic uncertainty requiring bone marrow biopsy or specialist evaluation

›Significant comorbidities increasing hemorrhage risk

›Social concerns or inability to ensure reliable follow-up

›Failure to respond to outpatient treatment

ICU-level care

›ICU admission triggers

›Confirmed or suspected intracranial hemorrhage

›Hemodynamic instability despite resuscitation

›Active life-threatening bleeding requiring combined emergency therapy

›Airway compromise from oropharyngeal hemorrhage

›Concurrent TTP diagnosis requiring plasmapheresis

Safe discharge criteria

›Outpatient management appropriate when

›Platelets ≥20 x 10³/μL with no or minor bleeding

›Established ITP with platelets <20 x 10³/μL if asymptomatic and previously responsive to rescue agents

›Reliable hematology follow-up confirmed within 24–72 hours

›Patient able to return immediately for alarm symptoms

›No diagnostic uncertainty

Consultation and follow-up

›Hematology consultation

›All newly diagnosed ITP: hematology follow-up within 24–72 hours

›Urgent consultation for diagnostic uncertainty, refractory disease, or splenectomy consideration

08Treatment/t85

Emergency treatment for critical bleeding

›Combined emergency protocol (McMaster Guideline 2026, Blood Advances)

›Platelet transfusion

›1–2 apheresis units

›Transient effect only; use concurrently with other agents

›Do not transfuse prophylactically without active bleeding

›High-dose corticosteroids

›Methylprednisolone 1 g IV daily x 3 days

›OR dexamethasone 40 mg IV daily x 4 days

›IVIG

›1 g/kg IV day 1

›Repeat 1 g/kg IV day 2 if inadequate response

›Platelet rise expected within 1–4 days

›Effect duration 1–2 weeks

›Tranexamic acid

›1 g IV for mucosal or systemic bleeding

›OR 1.3 g PO TID for ongoing mucosal hemostasis

›TPO-receptor agonist (initiate immediately)

›Romiplostim 1 μg/kg SC as starting dose

›OR eltrombopag 50 mg PO daily (Asian patients 25 mg PO daily)

›Discontinue anticoagulants and antiplatelet agents

›Conditional recommendation against recombinant factor VIIa (thrombosis risk)

First-line treatment for non-critical ITP

›Corticosteroid therapy

›Prednisone 1–2 mg/kg/day PO x 1–2 weeks then taper

›~80% initial response rate

›>50% relapse on taper

›Taper over 4–6 weeks to minimize relapse

›Dexamethasone 40 mg PO daily x 4 days (pulse)

›May repeat up to 4 cycles at 2–4 week intervals

›Comparable efficacy to prednisone with shorter exposure

›Avoid prolonged high-dose courses >6 weeks (diabetes, osteoporosis, infection risk)

›IVIG (first-line adjunct or alternative)

›Indications: active serious bleeding, pre-procedure with platelets <50 x 10³/μL, rapid rise needed

›1 g/kg x 1–2 days

›~80% response rate; effect transient (1–2 weeks)

›Anti-D immunoglobulin

›50–75 μg/kg IV in Rh-positive non-splenectomized patients

›Alternative to IVIG when cost or availability is a concern

›Contraindicated in Rh-negative patients and post-splenectomy

Observation without treatment

›Criteria for observation only

›Platelets ≥30 x 10³/μL

›Asymptomatic or minor skin bleeding only

›No procedures planned

›Follow-up within 1–2 weeks confirmed

Second-line and refractory treatment

›TPO-receptor agonists (preferred for chronic/refractory ITP)

›Romiplostim SC weekly

›Starting dose 1 μg/kg SC weekly

›Titration by 1 μg/kg/week to maintain platelets 50–200 x 10³/μL

›Maximum 10 μg/kg/week

›Monitor CBC weekly until stable

›Eltrombopag PO daily

›Starting dose 50 mg PO daily (25 mg in Asian patients or hepatic impairment)

›Titration by 25 mg every 2 weeks

›Maximum 75 mg/day

›Take on empty stomach; avoid dairy, calcium, iron within 4 hours before and 2 hours after

›Monitor LFTs at baseline and every 2 weeks during titration

›Eltrombopag approved in pediatric ITP ≥1 year (JAMA 2025 evidence)

›Avatrombopag PO daily

›Starting dose 20 mg PO daily

›Maximum 40 mg/day

›No dietary restrictions (no chelation effect)

›Risk of rebound thrombocytopenia on abrupt discontinuation

›Rituximab

›375 mg/m² IV weekly x 4 doses

›Sustained response ~60% at 6 months, ~30% at 2 years

›Screen for HBV before use (risk of reactivation)

›PML risk (very rare, reported)

›Slower onset than corticosteroids (2–8 weeks)

›Fostamatinib

›100 mg PO BID; increase to 150 mg PO BID if tolerated and needed

›For chronic ITP refractory to at least 1 prior therapy

›Monitor blood pressure (hypertension risk) and LFTs

›Splenectomy

›Reserved for chronic ITP >12 months refractory to medical therapy

›Cure rate ~60–65% long-term

›Administer pneumococcal, meningococcal, and Hib vaccines ≥2 weeks prior

›Laparoscopic approach preferred

›Lifelong infection prophylaxis post-splenectomy

Medications to avoid in ITP

›Contraindicated medications

›NSAIDs and aspirin (impair platelet function, increase bleeding risk)

›Anticoagulants during active bleeding; reintroduce only when platelets >50 x 10³/μL

›Drugs known to cause thrombocytopenia (quinine, quinidine, heparin, carbamazepine, vancomycin, rifampicin, TMP-SMX)

H. pylori eradication

›Triple therapy if H. pylori positive

›Amoxicillin 1 g PO BID + clarithromycin 500 mg PO BID + PPI x 14 days

›Platelet response may occur weeks to months after eradication

›Class IIa recommendation (ASH 2019)

09Special Populations/sp66

Pregnancy

›Physiologic context

›Gestational thrombocytopenia accounts for ~75% of thrombocytopenia in pregnancy

›Usually mild platelet count >70 x 10³/μL

›Third trimester predominant, resolves postpartum

›Distinguishing ITP from gestational thrombocytopenia

›Platelet count <70 x 10³/μL more consistent with ITP

›First or second trimester presentation more consistent with ITP

›Prior history of thrombocytopenia outside pregnancy

›ACOG Practice Bulletin 207 (2019) guides management

›Diagnosis workup in pregnancy

›Exclude preeclampsia, HELLP syndrome (elevated BP, LFTs, hemolysis)

›Exclude TTP (schistocytes, elevated LDH, low ADAMTS13)

›Antiphospholipid syndrome screening

›Treatment in pregnancy

›First-line: prednisone 10–20 mg/day, lowest effective dose

›IVIG 1 g/kg for active bleeding or urgent platelet rise pre-delivery

›TPO-receptor agonists: safety in pregnancy not established, avoid if possible

›Rituximab: contraindicated in pregnancy

›Target platelet count ≥30 x 10³/μL for vaginal delivery

›Target platelet count ≥50 x 10³/μL for cesarean section

›Target platelet count ≥80 x 10³/μL for neuraxial anesthesia (epidural/spinal)

›Neonatal considerations

›Maternal IgG antibodies cross placenta; neonatal thrombocytopenia possible

›Neonatal platelet nadir at 2–5 days of life

›Fetal scalp sampling or cordocentesis not routinely indicated

›Vaginal delivery is safe; fetal platelet count does not reliably predict neonatal outcomes

Geriatric

›Age-specific risk profile

›ITP incidence increases after age 60 with equal sex distribution

›Higher bleeding risk at any platelet count due to frailty and comorbidities

›VTE risk doubled despite thrombocytopenia (consider if anticoagulation needed)

›Comorbidity interactions

›Anticoagulation indications (atrial fibrillation, VTE) complicate management

›Corticosteroid risks amplified (diabetes, osteoporosis, delirium, infection)

›Polypharmacy increases drug-induced thrombocytopenia risk

›Modified treatment approach

›Prefer pulse dexamethasone over prolonged prednisone

›IVIG well-tolerated in elderly; monitor renal function and volume status

›TPO-receptor agonists generally well-tolerated; monitor for thrombosis

›Splenectomy higher operative risk; thorough surgical risk assessment required

›Falls risk assessment essential (helmets, environment modification for severe thrombocytopenia)

Pediatrics

›Pediatric ITP characteristics

›Acute ITP predominates in children

›Often post-viral or post-vaccination

›Spontaneous remission in 80–90% within 6–12 months

›Chronic ITP develops in ~10–20% of children

›Peak age 2–5 years; no sex predominance in childhood

›Bleeding risk lower for equivalent platelet count vs. adults

›Diagnosis in children

›Peripheral smear essential to exclude leukemia and TTP

›Bone marrow biopsy not required unless atypical features (other cytopenias, hepatosplenomegaly, lymphadenopathy)

›Secondary causes less common in children vs. adults

›Treatment thresholds in children

›ASH 2019 guideline: observation acceptable for most children with platelets <20 x 10³/μL and minor bleeding

›Treatment for clinically significant bleeding or very low platelets (<10 x 10³/μL)

›Activity restriction more important than pharmacotherapy for mild disease

›First-line treatment in children

›Corticosteroids: prednisone 1–2 mg/kg/day (max 60 mg/day) x 2–4 weeks

›OR dexamethasone 0.6 mg/kg/day (max 40 mg/day) x 4 days

›IVIG 0.8–1 g/kg x 1–2 days

›Second-line in pediatric ITP

›Eltrombopag approved for children ≥1 year (JAMA 2025, pediatric ITP trial)

›25 mg/day in children 1–5 years (adjusted by weight and response)

›50 mg/day in children ≥6 years

›Romiplostim for chronic refractory pediatric ITP

›Rituximab for chronic/refractory disease (off-label)

›Splenectomy generally deferred until age 5 and >12 months from diagnosis

10Background/b55

Epidemiology

›Incidence and prevalence

›Incidence 2–5 per 100,000 person-years

›Bimodal age distribution

›Young adults 20–30 years (slight female predominance)

›Older adults >60 years (equal sex distribution)

›Chronic ITP (>12 months) develops in up to 70% of adult patients

›Spontaneous remission can occur even years after chronic diagnosis

›Clinical course and outcomes

›Only ~5% of ITP patients present with severe bleeding

›~15% develop bleeding requiring hospitalization within 5 years

›VTE risk is twice that of the general population despite low platelets

›ICH is the most feared complication but occurs in <1% of patients

›Fatigue and impaired quality of life common even without bleeding

›Classification by duration

›Newly diagnosed ITP: within 3 months of diagnosis

›Persistent ITP: 3–12 months from diagnosis

›Chronic ITP: >12 months duration

›Refractory ITP: failure of corticosteroids + splenectomy

Pathophysiology

›Immune mechanism

›Acquired autoimmune disorder

›Autoantibodies (IgG) target platelet surface antigens (GPIIb/IIIa, GPIb/IX)

›Antibody-coated platelets destroyed by splenic macrophages via Fc receptor

›Hepatic clearance of opsonized platelets also contributes

›Impaired platelet production

›Anti-platelet antibodies also target megakaryocytes in bone marrow

›TPO levels relatively normal (not elevated as expected) — key pathophysiologic insight

11Patient Discharge Instructions/pdi26

copy discharge instructions

›What is ITP?

›ITP (Immune Thrombocytopenic Purpura) is a condition where your immune system attacks and destroys your blood platelets

›Platelets are needed to form clots and stop bleeding

›This can cause bruising, tiny red spots on the skin (petechiae), and abnormal bleeding

›Your medications

›Take all prescribed medications as directed

›If prescribed prednisone or dexamethasone, do not stop suddenly without talking to your doctor

›Avoid aspirin, ibuprofen, naproxen, and other NSAIDs — these thin the blood further

›Avoid alcohol — it can lower your platelet count further

›If taking eltrombopag, take on an empty stomach; avoid dairy, calcium, iron, or antacids within 4 hours before or 2 hours after

›Activity and safety

›Avoid contact sports, rough play, or activities with high fall or injury risk while platelets are low

›Wear protective headgear for any activity with head injury risk

›Use a soft toothbrush and electric razor to minimize cuts

›Consider wearing a medical alert bracelet

›Follow-up appointment

›Return to your hematologist or doctor within 24–72 hours for a repeat blood test

›Bring a list of all your current medications to every appointment

›Return immediately to the Emergency Department if you experience

›Sudden severe headache, confusion, vision changes, or weakness (possible brain bleed)

›Blood blisters in your mouth (wet purpura)

›Nosebleed that does not stop with 20 minutes of continuous pressure

›Blood in urine or stool, or vomiting blood

›Heavy or prolonged menstrual bleeding

›Dizziness, fainting, or feeling very weak

›Significant new bruising much worse than your baseline

12References/r22

Guidelines and key sources

›Cooper N, Ghanima W. Immune Thrombocytopenia. N Engl J Med. 2019;381:945–955

›Comprehensive review of ITP pathophysiology, diagnosis, and management

›Neunert C, Terrell DR, Arnold DM, et al. American Society of Hematology 2019 Guidelines for Immune Thrombocytopenia. Blood Advances. 2019;3(23):3829–3866

›ASH evidence-based guideline on diagnosis, treatment thresholds, and therapy selection

›Chowdhury SR, Sirotich E, Guyatt GH, et al. Guideline on the Emergency Management of Critical Bleeding in Patients With Immune Thrombocytopenia. Blood Advances. 2026

›McMaster ITP Emergency Management Guideline 2026; combined emergency protocol

›Gauer RL, Whitaker DJ. Thrombocytopenia: Evaluation and Management. Am Fam Physician. 2022;106(3):275–285

›Practical primary care approach including differential diagnosis and disposition

›Jones DE, Walker JJ, Abellada AMP. Hematologic Emergencies: Recognition and Initial Management. Am Fam Physician. 2024

›Emergency recognition and management of thrombocytopenic emergencies

Additional references

›DeSouza S, Angelini D. Updated Guidelines for Immune Thrombocytopenic Purpura: Expanded Management Options. Cleve Clin J Med. 2021;88(12):680–689

›Updated management including TPO-receptor agonists and fostamatinib

›Shimano KA, Grimes AB, Kaicker S, et al. Eltrombopag for Newly Diagnosed Pediatric Immune Thrombocytopenia Requiring Treatment. JAMA. 2025

›Pediatric ITP eltrombopag efficacy and safety trial

›ACOG Practice Bulletin No. 207. Thrombocytopenia in Pregnancy. Obstet Gynecol. 2019;133(3):e181–e193

›Guidance on distinguishing gestational thrombocytopenia from ITP in pregnancy

›Pishko AM, Li A, Cuker A. Immune Thrombotic Thrombocytopenic Purpura. JAMA. 2025

›Differentiating TTP from ITP; ADAMTS13 testing and management

›Witkowski M, Witkowska M, Robak T. Autoimmune thrombocytopenia: Current treatment options in adults with a focus on novel drugs. Eur J Haematol. 2019;103(6):531–541

›Second-line treatment options including fostamatinib and novel TPO-RAs

›Kashiwagi H, Kuwana M, Murata M, et al. Reference Guide for the Diagnosis of Adult Primary Immune Thrombocytopenia, 2023 Edition. Int J Hematol. 2024

›Japanese consensus diagnostic criteria and updated adult ITP reference guide

Learn More: Immune Thrombocytopenic Purpura (ITP)→

Comprehensive Clinical Review

Structured, evidence-informed, long-form analysis for deeper understanding.

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed August 18, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.