When you have chronic immune thrombocytopenia (cITP), you don’t have enough platelets in your blood. This means you might bleed if your platelet count is low or bleed too much when you’re injured. Your doctor will prescribe medicine to get your platelet count up. Treatment differs based on whether you are experiencing critical severe bleeding, minor bleeding, or no bleeding, but are at high risk for bleeding.
There are lots of medicines for cITP. You and your doctor will weigh the pros and cons of each to make sure you get the best one for you.
Corticosteroids (Steroids)
Doctors usually try steroids first. They’re similar to a hormone made by your adrenal glands. You’ll probably get one of two types to help treat your cITP.
Prednisone (Deltasone, Rayos) is the most common. It helps slow the breakdown of your platelets. You take it as a pill every day for 2 to 4 weeks, then slowly lower the dose until you’re off it completely.
Sometimes your doctor might prescribe a high dose of a steroid called dexamethasone (Decadron) instead. You take it for 4 days every 2 to 4 weeks. It works faster, but the end results are about the same.
You usually don’t take steroids for long. They can cause serious side effects, like:
- Cataracts
- High blood sugar
- High blood pressure
- Mood changes
- Heart problems
- Weak bones (a condition called osteoporosis)
These often get worse the longer you take the drug. You might have side effects when you come off steroids, too. Talk with your doctor about whether these medicines are right for you.
Intravenous Immune Globulin (IVIG)
This is also often used first. Your doctor may prescribe it to stop bleeding fast.
Immune globulins are proteins in your blood called antibodies. Your immune system makes them to fight germs, but in this case, immune globulins interfere with the destruction of your platelets by the spleen.. You can also get them from a blood donor to boost your platelet count.
They’re given through a vein (IV). The treatment takes a few hours and usually starts slowly. If you have side effects, it may be slowed down or stopped.
You might get a high dose of immune globulin for a day or two, or a lower dose over 5 days. The high dose gets your platelets up faster. But you may have more side effects, like:
- Fever
- Chills
- Nausea
- Vomiting
- An allergic reaction
Side effects can happen during your treatment or days later.
You take medicine before the treatment and at home to help lower your chance of problems.
Anti-RhoD (Anti-D)
This is another type of immune globulin treatment. It costs less than IVIG and takes a few minutes instead of hours.
Your doctor might choose anti-D if you have a protein in your blood called Rh factor. When you have this protein, anti-D can boost your platelet count.
Before you start treatment, you’ll have tests to make sure you have the right blood type. You’ll also get medicine to help ease side effects like chills, fever, headaches, and body aches.
A few people may get severe anemia (not enough healthy red blood cells) or have organ failure after the treatment. These can be very serious. Your doctor will watch you closely for any problems.
Thrombopoietin-Receptor Agonists (TPO-RAs)
Drugs in this class include: avatrombopag (Doptelet), eltrombopag (Promacta), and romiplostim (Nplate). They help your body make more platelets and may also boost your immune system.
Your doctor might try one of these if other treatments haven’t worked for you.
TPO-RAs may also be combined with a steroid like dexamethasone for better results.
For cITP, you take Promacta as a pill every day. Nplate is given as a shot once a week. Avatrombopag (Doptelet) is taken once a day and then the dose is adjusted to your platelet count..
These medicines can cause:
- A tired feeling
- Blood clots
- Headaches
Fostamatinib (Tavalisse)
This is a tablet you take twice a day. It helps create more blood platelets for some people who weren’t helped by other treatments.
For most people, side effects are mild. But in rare cases it can make you less able to fight infections, raise your blood pressure, or cause liver problems. Serious allergic reactions are also possible but rare.
Rituximab (Rituxan)
This medicine is approved for cancer and arthritis but not cITP. Still, your doctor may try it if other treatments haven’t helped. It raises your platelet count by changing the way other blood cells work.
You get it through a vein in your arm. This is called an infusion. Your first infusion may last 4 to 6 hours. You usually have one a week for 4 weeks.
Rituxan can cause serious side effects. One of the most common is a reaction to the infusion. If this happens, it’s usually shortly after you start your first dose. A health care professional will watch you closely for any problems. Other side effects include severe skin or mouth sores and a rare brain infection called PML.
Be sure you understand all the pros and cons of this medicine before you start treatment.