Stasi and Provan listed the various factors which affect the decision whether to treat a patient with immune thrombocytopenic purpura (ITP). The authors are from Regina Apostolorum Hospital in Albano Laziale, Italy, St. Bartholomew's Hospital and the Royal London Hospital.
Factors affecting decisions to treat a patient with ITP:
(1) age
(2) level of physical activity (and chance of trauma)
(3) need for surgery
(4) concurrent diseases
(5) concurrent medications
(6) active bleeding
(7) platelet count
(8) possible complications of therapy
(9) patient preferences
A child can tolerate a very low platelet count without excessive bleeding, while an older adult (> 60 years) is more likely to experience significant bleeding.
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External Considerations
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Minimum Platelet Count
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physical occupation
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50,000 per µL
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athlete in contact sport
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80,000 per µL
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minor surgery
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50,000 per µL
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major surgery
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80,000 - 100,000 per µL
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Diseases that may increase the risk of bleeding:
(1) uremia
(2) poorly controlled hypertension
(3) fever
(4) concurrent infection
(5) alcoholism or chronic liver disease
(6) aneurysm or other vascular disease
(7) malnutrition, especially vitamin K deficiency
(8) peptic ulcer disease or other gastrointestinal bleeding disorder
Concurrent medications:
(1) antiplatelet drugs (aspirin, NSAID, glycoprotein IIb/IIIa inhibitors)
(2) anticoagulants
(3) antibiotics
(4) myelosuppressing agents
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Active Bleeding
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Platelet Count
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Need for Active Therapy
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yes
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NA
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yes
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no
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< 10,000 per µL
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probably
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no
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10,000 - 30,000 per µL
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possibly (depending on occupation, drugs, etc)
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no
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> 30,000 per µL
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usually not (unless at risk for trauma or needs surgery)
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