Immune thrombocytopenic purpura in adults. Review uri icon

Overview

abstract

  • PURPOSE OF REVIEW: A review of recent studies was conducted to determine if guidelines promulgated by the American Society of Hematology and the British Committee for Standards in Haematology need to be updated as these were based mainly on expert opinion rather than outcomes derived from clinical trials. RECENT FINDINGS: Recent studies suggest that most patients with immune thrombocytopenic purpura have a disease that is generally well tolerated, with little morbidity. Splenectomy remains the best 'curative' treatment for adults with chronic disease (at least 6 months of follow up). Other treatments such as anti-D, rituximab or dexamethasone may allow the decision of splenectomy to be postponed, possibly indefinitely, if hemostatic platelet count is attained. Mortality from bleeding may be relevant only in patients refractory to splenectomy. Cytotoxic agents should be reserved for patients with bleeding refractory to other treatments. SUMMARY: Patients with platelet counts less than 30 x 10(9)/l or bleeding have to be treated but management decisions should also be based on lifestyle, age, and other medical conditions that may contribute to the risk of serious bleeding. An aggressive therapeutic approach is justified only in patients with platelet counts below 20 x 10(9)/l and those refractory to splenectomy. Newer therapies may be more targeted in their action.

publication date

  • September 1, 2007

Research

keywords

  • Anti-Inflammatory Agents
  • Antibodies, Monoclonal
  • Dexamethasone
  • Purpura, Thrombocytopenic, Idiopathic
  • Rho(D) Immune Globulin
  • Splenectomy

Identity

Scopus Document Identifier

  • 34648836081

Digital Object Identifier (DOI)

  • 10.1097/MOH.0b013e3282b9748f

PubMed ID

  • 17934364

Additional Document Info

volume

  • 14

issue

  • 5