Initial management of immune thrombocytopaenia in adults based on risk stratification

Patients with immune thrombocytopaenia (ITP) have a wide spectrum of disease severity and bleeding risk even at similar platelet counts. Hence, additional clinical and laboratory factors may be considered in the evaluation of bleeding risk in ITP. Risk stratification based on predicted bleeding risk...

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Published inPostgraduate medical journal Vol. 95; no. 1128; pp. 558 - 562
Main Authors Umakanthan, Jaydev Manikkam, Dhakal, Prajwal, Gundabolu, Krishna, Kallam, Avyakta, Almquist, Daniel R, Bhatt, Vijaya Raj
Format Journal Article
LanguageEnglish
Published England Oxford University Press 01.10.2019
Subjects
Adult
Age
Blood platelets
Dexamethasone - administration & dosage
Dose-Response Relationship, Drug
Drug Resistance
Glucocorticoids - administration & dosage
Hematology
Hemorrhage - etiology
Hemorrhage - prevention & control
Humans
Immunotherapy
Laboratories
Mean Platelet Volume
Monoclonal antibodies
Platelet Count
Purpura, Thrombocytopenic, Idiopathic - blood
Purpura, Thrombocytopenic, Idiopathic - drug therapy
Risk Assessment
Steroids
Systematic review
Working groups
dexamethasone
bleeding risk
steroids
immune thrombocytopenia
thromboelastography
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Summary:Patients with immune thrombocytopaenia (ITP) have a wide spectrum of disease severity and bleeding risk even at similar platelet counts. Hence, additional clinical and laboratory factors may be considered in the evaluation of bleeding risk in ITP. Risk stratification based on predicted bleeding risk may help to identify high-risk patients and guide the initial management of ITP in adults requiring treatment. Recent evidence supports the use of high-dose dexamethasone therapy over prednisone in the initial management of ITP because of improved initial response rates, shorter median time to response and better safety profile. A risk-stratified approach to management of ITP is hoped to reduce bleeding complications in high-risk patients; however, the outcomes of such management approach need to be studied prospectively. Additionally, whether therapy intensification or combination of dual therapy such as intravenous immunoglobulin or rituximab in combination with dexamethasone can reduce bleeding complications in high-risk ITP should be studied in the future.
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ISSN:0032-5473
1469-0756
DOI:10.1136/postgradmedj-2019-136636