Patients with primary thrombocytopenia who have a platelet count ≥30 x 10^9/L, no bleeding manifestations and are not working in a job that increases the risk of bleeding, and have no risk factors for bleeding, may be followed up with observation without treatment. If the patient has active bleeding symptoms, treatment should be given regardless of the degree of thrombocytopenia.
The first-line therapeutic agent for primary thrombocytopenia is glucocorticoids, high-dose dexamethasone administered orally or intravenously, which may be repeated for 1 cycle in patients with ineffective or relapsed disease. During the course of treatment, blood pressure and blood glucose levels should be monitored, and care should be taken to prevent infections and peptic ulcers. In addition C immunoglobulin is mainly used for emergency treatment, glucocorticoid intolerance or contraindication patients.
Treatment should follow the principle of individualization, encouraging patients to participate in treatment decision-making, taking into account the patient’s wishes, on the basis of minimizing the adverse effects of treatment to raise the platelet count to a safe level, reduce bleeding events, and pay attention to the patient’s health-related quality of life. Medication use needs to be under the direction of a physician.