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Initial management of immune thrombocytopaenia in adults based on risk stratification
  1. Jaydev Manikkam Umakanthan1,
  2. Prajwal Dhakal1,
  3. Krishna Gundabolu1,
  4. Avyakta Kallam1,
  5. Daniel R Almquist2,
  6. Vijaya Raj Bhatt1
  1. 1 Department of Internal Medicine, Division of Oncology and Hematology, University of Nebraska Medical Center, Omaha, Nebraska, USA
  2. 2 Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
  1. Correspondence to Dr Prajwal Dhakal, Department of Internal Medicine, Division of Oncology and Hematology, University of Nebraska Medical Center, Omaha, NE 68105, USA; prazwal{at}gmail.com

Abstract

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.

  • immune thrombocytopenia
  • bleeding risk
  • thromboelastography
  • steroids
  • dexamethasone
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Footnotes

  • Contributors All authors contributed to the manuscript. JMU and VRB conceived and planned the idea. JMU wrote majority of the manuscript. All authors contributed to editing and finalising the whole manuscript.

  • Funding This work was supported by the National Institute of General Medical Sciences (1 U54 GM115458), which funds the Great Plains IDeA-CTR Network, and the Fred and Pamela Buffett Cancer Center Support Grant from the National Cancer Institute (P30 CA036727). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

  • Competing interests VRB reports receiving consulting fees from Pfizer, CSL Behring, Agios, AbbVie, Partner Therapeutics and Incyte, and research funding from Incyte, Tolero Pharmaceuticals and National Marrow Donor Program.

  • Patient consent for publication Not required.

  • Ethics approval This article does not contain any studies with human participants or animals performed by any of the authors.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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