Thrombocytopenia
Also known as: HIT · immune thrombocytopenia · ITP · low platelets · TTP
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American Society of Hematology 2019 guidelines for immune thrombocytopenia
American Society of Hematology (ASH) · 2019
The current US hematology-society guideline for primary immune thrombocytopenia, covering both adults and children. Immune thrombocytopenia is used here as the representative condition for the broader thrombocytopenia topic. The guideline addresses when treatment is needed at all, how corticosteroids should be used, and how to approach second-line options.
Updated international consensus report on the investigation and management of primary immune thrombocytopenia
International Working Group on Immune Thrombocytopenia (International Consensus Report panel) · 2019 · 2019 update
An international consensus report on primary immune thrombocytopenia, listed with GLOBAL region because the panel is multinational rather than tied to a US or EU society. It covers diagnosis and management in adults, in pregnancy and in children, and adds explicit attention to patient quality of life.
- Provides consensus recommendations for adults, pregnancy and paediatric immune thrombocytopenia in a single document. source
- Updates the 2010 International Consensus Report, based on a review of literature published between 2009 and 2018. source
- Published in Blood Advances in 2019 (volume 3, pages 3780-3817), lead author Drew Provan. source
US vs EU key differences
- The treatment threshold in newly diagnosed adult ITP is expressed differently: ASH recommends observation rather than corticosteroids at platelet counts ≥30 x 10^9/L in patients who are asymptomatic or have only minor mucocutaneous bleeding, while the international consensus report says treatment is rarely indicated above 20 x 10^9/L without bleeding. source
- ASH sets an explicit corticosteroid ceiling, recommending a short course of prednisone of no more than 6 weeks including taper; the international consensus report instead describes prednisone 1 mg/kg for 2-3 weeks tapered off by 6-8 weeks, or dexamethasone 40 mg for 4 days repeatable up to three times. source
- Second-line therapy is ordered differently: ASH narrows the choice for corticosteroid-dependent or unresponsive ITP of at least 3 months' duration to either splenectomy or a thrombopoietin receptor agonist, whereas the international consensus report deliberately mandates no preferred sequence among TPO-RAs, rituximab, fostamatinib and immunosuppressives, leaving selection to patient factors, availability and cost. source
- Splenectomy timing differs in emphasis: ASH advises delaying splenectomy for at least 12 months from diagnosis, while the international consensus report suggests waiting 12 to 24 months to allow for spontaneous remission. source
- Only the international consensus report gives platelet targets for ITP patients on antiplatelet therapy (roughly 30-50 x 10^9/L on single-agent, 50-70 x 10^9/L on dual therapy or with anticoagulation); ASH set no target and flagged this as an unmet research need. source
What changed recently
- GLOBAL2010 → 2019 update2019-11-26
This report updates the 2010 International Consensus Report, regrading evidence published 2009-2018 and incorporating the newer agents (notably thrombopoietin receptor agonists) into the adult, paediatric and pregnancy treatment pathways, alongside new sections on quality of life.
source ↗curation confidence 90% - US2011 → 20192019-11-26
The 2019 ASH update replaced the 2011 guideline: corticosteroids (prednisone or dexamethasone) became the preferred first-line drug therapy in children over IVIg or anti-D, observation was favoured for children with no or mild bleeding, and thrombopoietin receptor agonists moved earlier in the second-line sequence ahead of rituximab and splenectomy.
source ↗curation confidence 90%
See the full update feed for changes across every system.