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Idiopathic Thrombocytopenic Purpura - ITP  




  • ITP is an acquired thrombocytopenia caused by autoantibodies against platelet antigens

  • ITT is a diagnosis of exclusion: one must exclude all other causes of nonimmune and immune platelet destruction, in a patient with isolated thrombocytopenia.

  • The goal of treatment in a non-surgical setting is not to normalize platelets, but rather to prevent significant bleeding

    • Critical bleeding events are treated with platelets transfusions, and glucocorticoids (typically, pulse dexamethasone) plus intravenous immune globulin (IVIG)

    • Severe bleeding events are treated with glucocorticoids

    • Therapies for refractor cases: Rituximab, TPO receptor agonist,  and Splenectomy




  • ↑ Risk of surgical bleeding and the need for a specific platelet count for surgery:

    • Hematology involvement is recommended

    • Platelet threshold discussion with surgeon, but generally keep platelets >50,000/microL for major surgery and >100,000/microL for neurosurgery

    • Platelets transfusions may be needed in emergency surgery

    • Steroids, IVIG, or a TPO receptor agonist like romiplostim can be used to help raise the platelet count

  • Neuraxial anesthesia considerations:

    • The exact platelet level for performing spinal and epidural techniques is controversial and varies by clinician

    • Generally, ITP patients may be safe to receive neuraxial anesthesia if the platelet count is >70,000/microL. 

    • Neuraxial anesthesia may be acceptable in patients with platelet counts between 50,000-70,000/microL where the risk:benefit analysis favors a neuraxial approach

    • Neuraxial anesthesia is contraindicated in those with platelet counts <50,000/microL

  • Considerations of medications a patient with ITP may be receiving


  • Adriana OD. Hematologic disorders. In: Hines R, Jones S, editors. In: Stoelting's Anesthesia and Co-Existing Disease. 8th Edition. Philadelphia, PA: Elsevier; 2021. p. 465-496.



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