Changes

*'''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'''.

*Adjunctive immunosuppressive therapy may be provided with '''ciclosporin''', '''azathioprine''' or '''cyclophosphamide'''.

*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.

*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.

*'''Splenectomy''' may be performed in cases refractory to medical management to remove the cells responsible for the phagocytosis of platelets. Whilst this can be considered in cases that have frequent relapses, the hepatic mononuclear phagocytic system can also destroy platelets so splenectomy does not always ameliorate symptoms.

*'''Splenectomy''' may be performed in cases refractory to medical management to remove the cells responsible for the phagocytosis of platelets. Whilst this can be considered in cases that have frequent relapses, the hepatic mononuclear phagocytic system can also destroy platelets so splenectomy does not always ameliorate symptoms.