HOW IS ITP TREATED? WHAT ARE THE SIDE EFFECTS OF TREATMENT? Most cases of childhood ITP get better without treatment. Simply monitoring the child’s platelet count, known as observation , is one type of treatment. With time, the body usually stops making antibodies against the platelets. Your child’s platelet count may be low for several weeks or months. As the antibody level decreases, the platelets are no longer destroyed, and the platelet count increases.
While waiting for the white blood cells to stop making these antibod - ies, the body is aware of the low platelet count. As a result, the bone marrow (where platelets are made) will work harder to produce young, larger platelets that can do the job of the many older, smaller platelets. Your healthcare provider may order blood tests to monitor your child’s platelet count. As the platelet count improves, these tests will be needed less often. If the platelet count is low because of a medication, then the medication may be stopped or changed. If the low platelet count is caused by an infection or immune system disorder, then that infection or disorder will be treated, if possible. Treatment for ITP will be required only if your child has a very low platelet count, is bleeding, or wants to participate in sports or other activities that require a higher platelet count. Treatments for ITP include medications and surgery. Your doctor or nurse practitioner will talk to you about the possible benefits and risks of different treatments. Together you can decide what treatment, if any, is best for your child.
Medications do not cure ITP. The most common medications used to treat ITP decrease the number of platelets being destroyed by the spleen. This will increase the platelet count to a safe range so the risk of serious bleed - ing is lowered. The body may still be making antibodies against the platelets, and treatments may need to be repeated for several weeks or months until the body stops destroying its own platelets. These medications include intravenous immune globulin (IVIG) and steroids. A newer class of medications, including romiplostim and eltrombopag, work by increasing the number of platelets made in the bone marrow. Intravenous Immune Globulin (IVIG) IVIG is made from the plasma of human blood. Blood is made up of three different types of cells (red cells, white cells, and platelets) and plasma (the liquid part of the blood). Immunoglobulins, or antibodies, are proteins in the plasma that help the body fight infections. Healthy people can donate their blood or plasma. Immunoglobulins are removed from the plasma of thousands of people and pooled together to make one dose of IVIG. The IVIG is treated to make the product pure (free of other blood proteins) and safe (free of viruses that can cause infection). It is not clear how IVIG works to treat ITP. In ITP, the spleen destroys antibody-coated platelets in the blood. The IVIG may bind to antibody receptors in the spleen. If the receptors in the spleen are blocked by IVIG, they cannot attach to the antibodies on the platelets. IVIG does not cure ITP but will usually result in a rapid (24–48 hours) platelet increase in more than 75% of chil - dren with ITP. This increase in platelets may last for several weeks. If the body is still making antibodies against the platelets when the IVIG is gone, the platelet count may start to drop again. IVIG is a liquid that is given into a vein (intravenously). Medicines can be used to numb the skin on your child’s hand or arm before the needle is placed into the vein. The IVIG infusion rate is started slowly and is then
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