Idiopathic Thrombocytopenic Purpura:  Treatment in Adults

Until recent years splenectomy had been generally considered the treatment of choice in idiopathic thrombocytopenic purpura (ITP).¹ It has become clear, however, that spontaneous remissions occur in most patients having the acute form of the disease,² and with the advent of adrenal steroids and improved methods of transfusing platelets, most writers now express a preference for medical therapy for these patients, at least initially for a period of several months.^3-6

In contrast to the general acceptance of medical therapy for patients with acute ITP, the proper therapy for patients with chronic ITP is a controversial subject. Data from one institution indicate a clear superiority of splenectomy in these cases, whereas the opinion from another medical center suggests that use of adrenal steroids is the treatment of choice and that splenectomy should be considered only if prolonged steroid therapy fails to control the disease.^7,8 Because of this