A common bleeding disorder due to immune destruction of platelets. To diagnose ITP, isolated thrombocytopenia is present (rest of the complete blood count, including an examination of the peripheral blood smear, is entirely normal). Clinically apparent associated conditions, drugs (e.g. penicillins, cephalosporins, quinine, rifampicin and heparin), or other agents that may cause thrombocytopenia are NOT present. Patients with suspected ITP should be tested for SLE and for HIV infection.


Thrombocytopenia with normal white cell count and red cell series. Anaemia may be present due to blood loss.

Peripheral blood smear to exclude RBC fragments. Smear may show large platelets.

Do INR and aPTT, which should be normal in ITP.

If there is a poor response to treatment do a bone marrow biopsy.



»     medication that affects platelet function, e.g. NSAIDs and aspirin,

»  platelet transfusions unless life-threatening bleeds,

»   dental procedures in acute phase, and

»   IM injections.

Reassure the patient that resolution usually occurs in acute ITP.

Medic alert bracelet.

Platelet transfusions may be given if surgery is required or in life-threatening bleeding.


Acute ITP 

  • Prednisone, oral, 2 mg/kg daily.
  • Taper dose once response is achieved, usually within 10–14 days.
  • Therapy may be required for a few months before prednisone is eventually discontinued.
  • Also indicated for HIV-associated immune thrombocytopenia. Also start combination antiretroviral therapy urgently in these patients.

Platelet transfusions

Platelet transfusions are only indicated in acute active bleeding uncontrolled by other means or before procedures. In an adult, 1 mega-unit of single donor, leucocyte depleted platelets is usually sufficient to control the bleeding initially. Platelet transfusions have limited benefit in this condition as platelets are rapidly destroyed by the immune system.




» All cases not responding to steroids and, in the case of HIV patients, not responding to ART – discuss with haematologist.

Reference and further reading

Standard Treatment Guidelines and Essential Medicines List for South Africa 2012 Edition


Our heartfelt thanks go to the National Essential Drugs List Committee and, in particular, the Expert Review Committee for the Hospital Level EDL (Adult) for their continued dedication and commitment to the process. Without your passion and technical expertise, this publication would not have been possible. We would also like to thank the many doctors, pharmacists, professional societies and other health care professionals who contributed by way of comment, remarks and the supply of appropriate evidence. Your
involvement in the consultative process is an integral part of the review and has undoubtedly contributed to the excellence of this edition.

Ms H Zeeman (Chairperson) Prof L Bamford
Dr F Benson Prof M Blockman
Prof GPG Boon Prof H Brits
Mr V Dalmini Prof M Freeman
Prof BB Hoek Prof PM Jeena
Ms Y Johnson Prof G Maartens
Prof B Maharaj Ms HM Marais
Dr T Mbengashe Mr HT Mphaka
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Prof AG Parrish Dr L Pein
Dr T Pillay Dr H Saeed
Mr GS Steel Ms N Thipa
Prof BW van de Wal
Mr GS Steel (Chairperson) Dr E Bera
Prof M Blockman Dr R de Waal
Dr I Hassen Prof G Maartens
Prof B Maharaj Dr M Mashabane
Ms J Munsamy Prof AG Parrish
Dr H Prozesky Dr H Saeed
Dr P Sinxadi
Prof J Anthony Prof S Arulkumaran
Dr K Bateman Prof J Carr
Prof F Cilliers Prof PJ Commerford
Dr M Giaquinto Dr T Habib
Prof D Hall Dr F Henning
Dr Khan Dr L Koning
Dr KA Lecuona Prof S Levin
Prof NS Levitt Prof P Manga


Dr J Moodley Prof J Moodley
Dr N Moran Dr C Nel
Prof K Newton Prof RC Pattison
Dr Sossa Prof G Todd
Dr C van Deventer Prof Z van der Spuy
Dr L Weich
Prof Jamila Aboobaker Ms Gayle Adams
Prof Gillian Ainsley Ms Gail Anderson
Prof John Anthony Prof BH Ascott-Evans
Dr KJ Bateman Dr S Beningfi eld
Prof Ahmed Bhigjee Dr Ulla Botha
Dr Belinda Bruwer Prof Alan Bryer
Prof Trevor Carmichael Prof James Carr
Dr Jan Chabalala Prof Patrick Commerford
Dr Halima Dawood Dr Elma de Vries
Dr Charles Dreyer Ms A DuToit
Dr H Duvenage Prof Roland Eastman
Prof Robin Emsley Dr LN Goldstein
Dr Trevor Gould Dr Franclo Henning
Dr Linda Hering Dr S Hitchcock
Prof Margaret Hoffman Dr L Jenkins
Prof R Jewkes Dr R Jina
Dr KD Jivan Dr Gregory Johnson
Dr Gerhard Jordaan Prof Francois Jordaan
Dr John Joska Prof PM Joubert
Dr E Karim Prof Bryan Kies
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Dr Karin Lecuona Dr E LeePan
Prof Dinky (Naomi) Levitt Prof BG Lindeque
Dr Richard Llewellyn Prof Pravin Manga
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Dr Estie Meyer Prof David Meyer
Dr Andre Mochan Dr Jennifer Moodley
Dr Z Moola Dr Neil Moran
Prof Ayesha Motala Dr GJ Muller
Dr Trusha Nana Dr Charles P Nel
Prof Dana Niehaus Prof Nicolas Novitsky
Dr S Oliver Dr S Oosthuizen
Dr Heidi Orth Dr Muhammed Osman
Dr S Paruk Dr Patel
Prof Willie Pienaar Dr Anersha Pillay
Dr Manesh Pillay Prof Fraser Pirie
Prof PJ Pretorius Prof FJ Raal
Dr Ramlall Dr KI Ranchod
Dr Robyn Rautenbach Dr A Rawlin


Prof Brian Rayner Prof Guy Richards
Dr JC Roberts Dr Andre KL Robinson
Dr Polla Roux Dr Shamima Saloojee
Dr MGL Spruyt Dr Klaas Stempels
Prof Mohamed Tikly Prof Gail Todd
Dr Marius Van Dyk Dr Surita van Heerden
Dr P van Zyl Dr Claire Van Deventer
Dr Jacqui Venturas Dr Chris Verster
Dr Lize Weich Dr Nicky Welsh
Prof David Whitelaw
Ms K Jamaloodien Ms J Munsamy
Dr R de Waal Prof D Pudifi n (Clinical editor)
Assistance was provided by:
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Mr Vishen Jugathpal Dr Sarisha Singh
Ms Trudy Leong Dr Dorah Diale
Ms K Jamaloodien
Ms Trudy Leong
Dr Dorah Diale
Mr M Molewa
Ms P Ngobese
Mr S Sello
Ms H Zeeman
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