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Diagnosis and Treatment of Idiopathic Thrombocytopenic Purpura: Recommendations of the American Society of Hematology

1997; American College of Physicians; Volume: 126; Issue: 4 Linguagem: Inglês

10.7326/0003-4819-126-4-199702150-00010

1539-3704

Renal Diseases and Glomerulopathies

Position Papers15 February 1997Diagnosis and Treatment of Idiopathic Thrombocytopenic Purpura: Recommendations of the American Society of HematologyAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-126-4-199702150-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail To develop guidelines for the diagnosis and management of idiopathic thrombocytopenic purpura (ITP) and to document the extent to which these guidelines are based on either scientific evidence or opinion, the American Society of Hematology established a panel composed of 13 hematologists with expertise in ITP, a clinical epidemiologist, and a practice guidelines methodologist.A comprehensive review was done of all published English-language studies that met explicit inclusion criteria and that evaluated the natural history of ITP or the effectiveness of testing and treatment options for ITP. The quality of each study was graded by two reviewers using formal methodologic rules. In subject areas for which data were inadequate, recommendations were based on opinion and were derived by using a formal scoring procedure. Confidential questionnaires were used to survey the hematologists on the panel about the appropriateness of testing and treatment options in hundreds of clinical scenarios. Practice recommendations were derived from the mean appropriateness scores for each indication. Voting was kept confidential to give each panel member an equal voice and to limit biases introduced by group dynamics. The recommendations were peer reviewed by eight outside experts.This report focuses on data on and recommendations for adults with ITP.Little high-quality scientific evidence with which to assess the efficacy of diagnostic tests and treatments for ITP is available. The opinion of the panel was that most diagnostic tests are unnecessary in the routine work-ups of patients suspected of having ITP and that ITP accompanied by severe bleeding requires treatment with glucocorticoids, intravenous immunoglobulin, and other measures. However, treatment and hospitalization are often unnecessary when patients have only mild or moderate thrombocytopenia or minimal bleeding. Special therapeutic measures are sometimes indicated in pregnant women with ITP.References1. George JN, Woolf SH, Raskob GE, Wasser JS, Aledort LM, Ballem PJ, et al. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood. 1996; 88:3-40. Google Scholar2. Brook RH, Chassin M, Fink A, Solomon D. A Method for the Detailed Assessment of the Appropriateness of Medical Technologies. A RAND Note. Santa Monica, CA: RAND; 1991: N-3376-HHS. Google Scholar3. George JN, El-Harake MA, Raskob GE. Chronic idiopathic thrombocytopenic purpura. N Engl J Med. 1995; 331:1207-11. Google Scholar4. George JN, El-Harake MA, Aster RH. Thrombocytopenia due to enhanced platelet destruction by immunologic mechanisms. In: Beutler E, Lichtman MA, Coller BS, Kipps TJ, eds. Williams Hematology. 5th ed. New York: McGraw-Hill; 1995:1315-55. Google Scholar5. Cortelazzo S, Finazzi G, Buelli M, Molteni A, Viero P, Barbui T. High risk of severe bleeding in aged patients with chronic idiopathic thrombocytopenic purpura. Blood. 1991; 77:31-3. Google Scholar6. Guthrie TH Jr, Brannan DP, Prisant LM. Idiopathic thrombocytopenic purpura in the older adult patient. Am J Med Sci. 1988; 296:17-21. Google Scholar7. Burrows RF, Kelton JG. Fetal thrombocytopenia and its relation to maternal thrombocytopenia. N Engl J Med. 1993; 329:1463-6. Google Scholar8. Burrows RF, Kelton JG. Pregnancy in patients with idiopathic thrombocytopenic purpura: assessing the risks for the infant at delivery. Obstet Gynecol Surv. 1993; 48:781-8. Google Scholar9. Burrows RF, Kelton JG. Low fetal risks in pregnancies associated with idiopathic thrombocytopenic purpura. Am J Obstet Gynecol. 1990; 163:1147-50. Google Scholar10. Daffos F, Capella-Pavlovsky M, Forestier F. Fetal blood sampling during pregnancy with use of a needle guided by ultrasound: a study of 606 consecutive cases. Am J Obstet Gynecol. 1985; 153:655-60. Google Scholar11. Garmel SH, Craigo SD, Morin LM, Crowley JM, D'Alton ME. The role of percutaneous umbilical blood sampling in the management of immune thrombocytopenic purpura. Prenat Diagn. 1995; 15:439-45. Google Scholar12. Lacey JV, Penner JA. Management of idiopathic thrombocytopenic purpura in the adult. Semin Thromb Hemost. 1977; 3:160-74. Google Scholar13. Jacobs P, Wood L, Novitzky N. Intravenous gammaglobulin has no advantages over oral corticosteroids as primary therapy for adults with immune thrombocytopenia: a prospective randomized dinical trial. Am J Med. 1994; 97:55-9. Google Scholar14. Rasmus KT, Rottman RL, Kotelko DM, Wright WC, Stone JJ, Rosenblatt RM. Unrecognized thrombocytopenia and regional anesthesia in parturients: a retrospective review. Obstet Gynecol. 1989; 73:943-6. Google Scholar15. Recommendations of the Advisory Committee on Immunization Practices: use of vaccine and immune globulins for persons with altered immunocompetence. MMWR Morb Mortal Wkly Rep. 1993; 42(RR-4):1-18. Google Scholar Author, Article, and Disclosure InformationAffiliations: Grant Support: In part by the American Society of Hematology.Corresponding Author: James N. George, MD, The University of Oklahoma Health Sciences Center, Hematology-Oncology Section, PO Box 26901, Oklahoma City, OK 73190.Current Author Addresses: Dr. George: The University of Oklahoma Health Sciences Center, Hematology-Oncology Section, PO Box 26901, Oklahoma City, OK 73190. 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