The process of confirming an ITP diagnosis may be long and frustrating, sometimes requiring many tests to rule out other conditions before finding the actual cause of your symptoms
If your platelet count is equal to or above 30,000/mcL and your symptoms are mild, your doctor may wait to see if your condition improves on its own
If symptoms such as bleeding become severe or if your platelet count falls below a safe level during this period, your doctor may start you on steroids, also known as corticosteroids, to boost your platelet count and reduce the risk of uncontrolled bleeds (step 3)
As many as 9 of 10 people may see an increase in their platelet counts with steroids. However, only about 2 of 10 people maintain their increase in platelets after they stop steroid treatment
If bleeding becomes severe or if your platelet levels drop, your doctor may prescribe steroids, also known as corticosteroids, (step 3) for a period of 6 weeks or less according to guidelines from the American Society of Hematology (ASH)—a group of experts that your doctor looks to for treatment recommendations
Once your platelet levels are increased, your doctor will gradually take you off steroids and continue to monitor your platelet count (Watch and Wait)
if your platelet count decreases again, your doctor may want to repeat steroid treatment. In fact, as many as 8 of 10 people taking steroids may see their platelet counts decrease after their doctor stops treatment
If your platelet count decreases again after you stop steroids, 1 of 2 things may happen:
Your doctor may try another cycle of steroid therapy to boost and try to stabilize your platelet count again
Although ITP isn't considered chronic until after you've had 12 months of unstable platelet counts, the 2019 ASH guidelines suggest that
If your platelet count is still unstable 12 months after you were diagnosed, your ITP is considered “chronic.” When this happens, ASH guidelines suggest switching to a or for treatment (step 4) if steroids aren’t working
2.
TPO-RAs are suggested as a treatment after steroids and may be preferred by those who prioritize long-lasting control of their platelet counts
TPO-RAs have been shown to boost the number of platelets in your body
If the TPO-RA working to stabilize your platelet count, your doctor will continue treatment and monitor your progress
While not everyone will respond to treatment, many have been shown to reach target levels between 1 and 3 weeks, and some have maintained that increase for several years
If the TPO-RA working, your doctor may try a monoclonal antibody or splenectomy (step 5)
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A monoclonal antibody is suggested as a treatment after steroids and may be preferred by those who want to avoid long-term medication
It may take weeks or months to see if a monoclonal antibody works for you
If the monoclonal antibody working, your doctor may try a TPO-RA or splenectomy (step 5)
Depending on local clinical guidelines, your doctor may require you to take antibiotics on a regular basis after you have a splenectomy
Splenectomy may be an effective option for some people to help stop the body’s immune system from destroying platelets
There are currently no tests to tell whether the procedure will work for you
It is recommended to wait at least 1 full year after an ITP diagnosis before considering splenectomy
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05 splenectomy
If TPO-RAs or the monoclonal antibody are not working, your doctor may suggest a splenectomy, which is the surgical removal of the spleen
Choosing to have a splenectomy is a major decision which may make some people feel nervous and worried about what to do next if the procedure doesn't work for them
04 MONOCLONAL ANTIBODY
04 MONOCLONAL ANTIBODY
When people find a treatment that not only increases their platelets but also lets them get back to living their life, they should continue to work closely with their doctor
NOTE: People who have had a splenectomy are already at increased risk for infection. Drugs that suppress your immune system like monoclonal antibodies further increase that risk. That’s why it’s important to have a discussion with your doctor before choosing your
next treatment
is not
04 TPO-RAs
is
is not
When people find a treatment that not only increases their platelets but also lets them get back to living their life, they should continue to work closely with their doctor
With the possibility of a complete recovery (also called remission) from ITP at this stage, people may feel hopeful yet nervous
BUT
For people whose platelets do not remain stable once treatment stops and need to restart steroids, this repeating “treatment loop” can be disappointing and frustrating
03 steroids not working
monoclonal antibody
TPO-RA
doctors can consider alternative treatment options if you have had as few as
3 months of unstable platelet counts despite steroid therapy
The potential of finding a different treatment that works can make people feel hopeful yet cautious at the same time
02 Steroids
01 diagnosis
After you receive an ITP diagnosis, it’s normal to feel scared about not knowing what to expect
02 watch and wait
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•
•
•
•
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1.
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05 splenectomy
01 diagnosis
02 watch and wait
02 steroids
03 steroids not working
04 TPO-RAs
04 MONOCLONAL ANTIBODY
SPLENECTOMY
05
MONOCLONAL ANTIBODY
TPO-RAs
04
03
STEROIDS
WATCH AND WAIT
02
DIAGNOSIS
01
01 diagnosis
02 watch and wait
02 steroids
03 steroids not working
04 TPO-RAs
04 MONOCLONAL ANTIBODY
05 splenectomy
•
After you receive an ITP diagnosis, it’s normal to feel scared about not knowing what to expect
01 diagnosis
02 watch and wait
•
•
02 Steroids
02 steroids
For people whose platelets do not remain stable once treatment stops and need to restart steroids, this repeating “treatment loop” can be disappointing and frustrating
BUT
•
•
With the possibility of a complete recovery (also called remission) from ITP at this stage, people may feel hopeful yet nervous
•
•
03 steroids not working
The potential of finding a different treatment that works can make people feel hopeful yet cautious at the same time
doctors can consider alternative treatment options
if you have had as few as
3 months of unstable platelet
counts despite steroid therapy
-
monoclonal antibody
TPO-RA
1.
•
04 TPO-RAs
When people find a treatment that not only increases their platelets but also lets them get back to living their life, they should continue to work closely with their doctor
is not
•
•
is
•
•
•
04 MONOCLONAL ANTIBODY
is not
•
NOTE: People who have had a splenectomy are already at increased risk for infection. Drugs that suppress your immune system like monoclonal antibodies further increase that risk. That’s why it’s important to have a discussion with your doctor before choosing your next treatment
When people find a treatment that not only increases their platelets but also lets them get back to living their life, they should continue to work closely with their doctor
•
•
05 splenectomy
Choosing to have a splenectomy is a major decision which may make some people feel nervous and worried about what to do next if the procedure doesn't work for them
•
•
•
If TPO-RAs or the monoclonal antibody are not working, your doctor may suggest a splenectomy, which is the surgical removal of the spleen
•