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Current approaches for the diagnosis and management of immune thrombocytopenia

  • Gafter-Gvili Anat
    Correspondence
    Correspondence to. Department of Medicine A and Institute of Hematology, Rabin Medical Center, Beilinson Hospital, Petah-Tikva 49100, Israel.
    Affiliations
    Department of Medicine A, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel

    Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Petah-Tikva, Israel

    Sackler Faculty of Medicine, Tel Aviv University, Israel
    Search for articles by this author
Published:November 21, 2022DOI:https://doi.org/10.1016/j.ejim.2022.11.022

      Highlights

      • The diagnosis of ITP is based on the exclusion of other causes of isolated thrombocytopenia.
      • Patient history, physical examination, blood count, and evaluation of the peripheral blood film.
      • Corticosteroids are the mainstay of initial treatment of ITP.
      • For subsequent therapy, the use of TPO-RAs, rituximab and fostamatinib, is supported by robust evidence.
      • Splenectomy should be considered for patients failing medical therapy.

      Abstract

      Immune thrombocytopenia (ITP), is an acquired autoimmune disorder characterized by the destruction of platelets and megakaryocytes, resulting in thrombocytopenia (platelet count <100 × 10⁹/L). This review focuses on the diagnosis and current management of ITP. The diagnosis of ITP is based principally on the exclusion of other causes of isolated thrombocytopenia using patient history, physical examination, blood count, and evaluation of the peripheral blood film. The clinical treatment goals should be to resolve bleeding events and to prevent severe bleeding episodes. The platelet count should be improved to attain a minimum of > 20–30 × 10⁹/L. Therapy should be given as an inpatient in newly diagnosed ITP with a platelet count of > 20 × 10⁹/L or if there is active bleeding. Corticosteroids are considered the standard initial treatment for newly diagnosed patients. Subsequent medical therapies with robust evidence include thrombopoietin receptor agonists (TPO-RAs), rituximab and fostamatinib. Surgical therapy with splenectomy may be considered for patients failing medical therapy. The choice between therapy options is highly dependent upon patient values and preferences.

      Keywords

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