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

For a patient with newly diagnosed immune thrombocytopenic purpura (ITP) and a platelet count of 30 × 109/L, the initial management should focus on assessing bleeding risk and considering treatment to raise the platelet count, especially if there is clinically significant bleeding or risk of bleeding.

Immediate referral to haematology is recommended for further evaluation and management, as platelet counts below 50 × 109/L warrant urgent specialist input NICE CKS.

First-line treatment typically involves corticosteroids to suppress immune-mediated platelet destruction, aiming to increase platelet counts and reduce bleeding risk Stasi & Provan 2004Kochhar & Neunert 2021.

In cases of significant bleeding or very low platelet counts, intravenous immunoglobulin (IVIG) may be used to rapidly increase platelet counts Ghanima et al. 2024Stasi & Provan 2004.

Platelet transfusions are generally not recommended routinely in autoimmune thrombocytopenia unless there is life-threatening bleeding or preparation for urgent invasive procedures, as transfused platelets are rapidly destroyed NICE NG24.

Close clinical monitoring for bleeding signs is essential, and supportive measures should be implemented as needed.

For patients with platelet counts around 30 × 109/L without bleeding, treatment decisions should be individualized based on bleeding symptoms, comorbidities, and patient preferences Kochhar & Neunert 2021.

Overall, the management approach integrates UK guidance on thrombocytopenia referral thresholds and transfusion practices NICE CKS,NICE NG24 with evidence-based treatment strategies from recent literature emphasizing corticosteroids and IVIG as frontline therapies Stasi & Provan 2004Ghanima et al. 2024.