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

Consider referring a patient with immune thrombocytopenic purpura (ITP) to a haematologist 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, urgent referral or immediate specialist advice is warranted due to the increased risk of spontaneous haemorrhage.
• If the platelet count is between 50 and 100 × 109/L and there is evidence of pancytopenia (haemoglobin <100 g/L, neutrophils <1 × 109/L), splenomegaly, lymphadenopathy, pregnancy, or upcoming surgical/interventional procedures, urgent referral should be arranged.
• For women with known ITP who are pregnant and have platelet counts below 50 × 109/L, discuss and agree a plan for intrapartum care with a multidisciplinary team including a haematologist.

These referral criteria help ensure timely specialist assessment and management to reduce bleeding risks and address underlying causes appropriately.

References: NICE CKS, NICE NG121