When should I consider referring a patient with ITP to a hematologist?

Consider referring a patient with immune thrombocytopenic purpura (ITP) to a hematologist in the following situations:

• If the platelet count is persistently below 100 × 10⁹/L and unexplained on at least two occasions 4–6 weeks apart.
• If the platelet count is less than 50 × 10⁹/L, especially if associated with active bleeding or before surgical or interventional procedures.
• If there is evidence of pancytopenia (e.g., haemoglobin less than 100 g/L, neutrophils less than 1 × 10⁹/L), splenomegaly, or lymphadenopathy.
• If the patient is pregnant with platelet counts between 50–100 × 10⁹/L, or if there are plans for delivery, to coordinate multidisciplinary care including a hematologist.
• If the thrombocytopenia is persistent and unexplained after excluding other causes and initial management.

Referral urgency depends on platelet count and clinical context: immediate referral or urgent specialist advice is needed if platelet count is less than 20 × 10⁹/L or if there is active bleeding, while urgent referral is advised for counts less than 50 × 10⁹/L ¹.

In pregnancy, management and referral should involve a hematologist to plan intrapartum care and reduce bleeding risks for mother and baby ².