Changes

The ultimate goal of the therapeutic regime is to control the autoimmune response to prevent further destruction of platelets. The bone marrow stem cells will then be able to replace the platelets that have been lost in the disease. A variety of drugs have been used in the treatment of ITP but those in widespread use include:

The ultimate goal of the therapeutic regime is to control the autoimmune response to prevent further destruction of platelets. The bone marrow stem cells will then be able to replace the platelets that have been lost in the disease. A variety of drugs have been used in the treatment of ITP but those in widespread use include:

*'''Corticosteroids''' including prednisolone and dexamethasone act to suppress cell- and antibody-mediated responses. These drugs act quickly, are frequently effective and are widely available, making them the most commonly used drugs in the management of ITP.

*'''Corticosteroids''' including prednisolone and dexamethasone act to suppress cell- and antibody-mediated responses. These drugs act quickly, are frequently effective and are widely available, making them the most commonly used drugs in the management of ITP.

*Adjunctive immunosuppressive therapy may be provided with '''ciclosporin''', '''azathioprine''' or '''cyclophosphamide'''. Ketaconazole can be used synergistically to reduce the dose of Cyclosporin/Ciclosporin used because of Ketaconazole's ability to inhibit the enzyme cytochrome P450.

*Adjunctive immunosuppressive therapy may be provided with '''ciclosporin''', '''azathioprine''' or '''cyclophosphamide'''. Ketaconazole and Cyclosporin can be used synergistically to reduce the dose of Cyclosporin/Ciclosporin used because of Ketaconazole's ability to inhibit the enzyme cytochrome P450.

*A recent prospective study indicated that '''human immunoglobulin''' may produce a significantly better outcome in cases of ITP. This product is thought to act by occupying sites (Fc receptors) on cells of the MPS that are usually used to recognise opsonised platelets and mediate phagocytosis.  Although it seems to be highly effective, this product is extremely expensive and is perhaps best indicated in actively bleeding or refractory cases.

*A recent prospective study indicated that '''human immunoglobulin''' may produce a significantly better outcome in cases of ITP. This product is thought to act by occupying sites (Fc receptors) on cells of the MPS that are usually used to recognise opsonised platelets and mediate phagocytosis.  Although it seems to be highly effective, this product is extremely expensive and is perhaps best indicated in actively bleeding or refractory cases.

*'''Vincristine''' is occasionally used in cases of severe thrombocytopaenia as it is thought to cause the release of platelets from the bone marrow.  The immature platelets released however are not completely functional. It also reduces macrophage function by inhibiting the assembly of microtubules necessary for phagocytosis.

*'''Vincristine''' is occasionally used in cases of severe thrombocytopaenia as it is thought to cause the release of platelets from the bone marrow.  The immature platelets released however are not completely functional. It also reduces macrophage function by inhibiting the assembly of microtubules necessary for phagocytosis.