Leading ITP clinicians come together and deliver consensus guidelines for the treatment of (ITP) in adult patients.
Local guidelines are needed to assist clinicians treating immune thrombocytopenic purpura (ITP) in Australia and New Zealand. Although many excellent summaries have recently been published for audiences elsewhere, we present our accumulated consensus perspectives on the diagnosis and management of ITP, specifically addressing clinically relevant areas where there are limitations to the available evidence1-3 (the guideline development process is described in the online Supporting Information, box). We are members of the Thrombosis and Haemostasis Society of Australia and New Zealand (THANZ).
This consensus statement has been endorsed by the THANZ Council and ITP Australia. ITP Australia provided patient perspective feedback on our recommendations.
The authors of the guidelines include a number of ITP Australia Medical Advisors and include: Philip YI Choi, Eileen Merriman, Ashwini Bennett, Anoop K Enjeti, Chee Wee Tan, Isaac Goncalves, Danny Hsu and Robert Bird. ITP Australia has provided patient perspective feedback.
The absence of high quality evidence for basic clinical dilemmas in immune thrombocytopenic purpura (ITP) underlines the need for contemporary guidelines relevant to the local treatment context. ITP is diagnosed by exclusions, with a hallmark laboratory finding of isolated thrombocytopenia.
Bleeding, family and medication histories and a review of historical investigations are required to gauge the bleeding risk and possible hereditary syndromes. Beyond the platelet count, the decision to treat is affected by individual bleeding risk, disease stage, side effects of treatment, concomitant medications, and patient preference. Treatment is aimed at achieving a platelet count > 20 × 109/L, and avoidance of severe bleeding. Steroids are the standard first line treatment, with either 6-week courses of tapering prednisone or repeated courses of high dose dexamethasone providing equivalent efficacy. Intravenous immunoglobulin can be used peri-procedurally or as first line therapy in combination with steroids.
Changes in management as a result of this statement:
There is no consensus on choice of second line treatments. Options with the most robust evidence include splenectomy, rituximab and thrombopoietin receptor agonists. Other therapies include azathioprine, mycophenolate mofetil, dapsone and vinca alkaloids. Given that up to one-third of patients achieve a satisfactory haemostatic response, splenectomy should be delayed for at least 12 months if possible. In life-threatening bleeding, we recommend platelet transfusions to achieve haemostasis, along with intravenous immunoglobulin and high dose steroids.
To review the guidelines in detail, review them below.
Source: Medical Journal of Australia
Publish Date: October 10, 2021