Abstract
Background and Objective Diagnosis and management of primary immune thrombocytopenia (ITP) have changed dramatically in the last decade. The aim of the study was to obtain information about the opinion of the Spanish ITP Group (GEPTI) members regarding the best clinical practices for diagnosis and management of adult patients with ITP. Materials and Methods A two-round Delphi method was carried out by sending to 129 experts a 90-item questionnaire developed by 11 specialists, with a 4-point Likert scale (“never,” “sometimes,” “frequently,” and “always”) for the assessment of responses. Results Forty out of the 129 experts participated in the survey (participation rate 30.2%) and 39 completed the questionnaire (response rate 97.5%). Salient consensus points included the following: the need to indicate workup studies from a sustained platelet count < 100 x 109/L in the absence of a clear etiology; bone marrow aspiration in elderly patients with suspected ITP; beginning treatment in asymptomatic patients with a platelet count < 20 x 109/L; not exceeding 6-7 weeks of corticosteroid therapy; switching from corticosteroids to one thrombopoietin receptor agonist (TRA); switching to other TRA or other options as combinations of them with immunosuppressive drugs in case of failure; how to reduce tapering TRA; treating patients with symptomatic persistent ITP and platelet count > 20 x 109/L; and considering mucosal or severe bleeding as a basic criterion for hospital admission. Conclusions The present consensus document provides a reference framework for the management of patients with ITP in clinical practice.
Highlights
Immune thrombocytopenia (ITP) is an acquired autoimmune disorder defined by isolated thrombocytopenia in the absence of other conditions associated with thrombocytopenia
Do you consider appropriate to initiate the study of thrombocytopenia from a sustained platelet count < 100 × 109/, and without any other clear cause that may justify it?
Do you consider appropriate to indicate a study of Helicobacter pylori a er diagnosis or suspicion of immune thrombocytopenia (ITP)?
Summary
Immune thrombocytopenia (ITP) is an acquired autoimmune disorder defined by isolated thrombocytopenia in the absence of other conditions associated with thrombocytopenia. Thrombocytopenia seems to be the result of dysregulation of the immune response, including the presence of antiplatelet antibodies, platelet destruction mediated by T-cells and the reticuloendothelial system, and impaired megakaryocyte function. The involvement of these pathogenic mechanisms may vary in the individual patient [2, 5,6,7]. Different consensus documents for the diagnosis and treatment of ITP published subsequently [9,10,11,12] have been of remarkable value to reduce heterogeneity in the classification of patients and to improve the design and interpretation of results of clinical trials. The present consensus document provides a reference framework for the management of patients with ITP in clinical practice
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