How should I approach the management of a patient with newly diagnosed ITP and a platelet count of 30 x 10^9/L?

In managing a patient with newly diagnosed immune thrombocytopenic purpura (ITP) and a platelet count of 30 x 109/L, the initial approach should focus on assessing bleeding risk and symptoms rather than platelet count alone. If the patient is asymptomatic or has only minor bleeding, immediate treatment may not be necessary, and careful observation with regular monitoring is appropriate. This is because many patients with platelet counts above 20-30 x 109/L and no significant bleeding can be managed conservatively NICE NG121.

If treatment is indicated due to bleeding symptoms or high bleeding risk, first-line therapy typically involves corticosteroids, such as prednisolone, to increase platelet counts and reduce immune-mediated platelet destruction. This aligns with both UK guidelines and recent literature emphasizing corticosteroids as initial treatment in symptomatic patients Stasi & Provan 2004Ghanima et al. 2024.

Intravenous immunoglobulin (IVIG) may be considered in cases of severe bleeding or when a rapid platelet increase is required. This is consistent with established practice and supported by expert reviews Stevens et al. 2006Ghanima et al. 2024.

Additional supportive measures include avoiding medications that increase bleeding risk and educating the patient about bleeding signs. Referral to a haematologist is recommended for ongoing management and consideration of second-line therapies if needed NICE NG121.

In summary, for a platelet count of 30 x 109/L in newly diagnosed ITP, observe if asymptomatic, initiate corticosteroids if bleeding or high risk, and consider IVIG for severe bleeding, with specialist input for further management Stasi & Provan 2004Ghanima et al. 2024.