First-Line Therapy for Immune Thrombocytopenia

Abstract

Immune thrombocytopenia (ITP) is an autoimmune disease affecting blood platelets that causes thrombocytopenia and an increased risk of bleeding. First-line therapy is indicated for patients with bleeding complications or who are at increased risk of bleeding, and the decision to initiate therapy depends not only on the platelet count, but also on other endpoints including quality of life. The choice of first-line therapy depends primarily on how quickly a platelet count response is required, with intravenous immune globulin providing the more rapid response, followed by high-dose dexamethasone and prednisone. In this narrative review, we discuss key issues with first-line therapy in ITP including when to initiate therapy, treatment options and special considerations for children. Evidence-based guidelines are lacking for the emergency management of patients with ITP who present with significant bleeding; we provide our approach to this critical situation.

Treatment of severe thrombocytopenia associated with systemic lupus erythematosus in pregnancy with eltrombopag: A case report and literature review

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Cerebellar hemorrhage due to immune thrombocytopenia

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“…La Sociedad Americana de Hematología ha establecido en 2019 unas normas para el manejo de los distintos escenarios dentro de la PTI para facilitar la toma de decisiones al personal sanitario. Esta guía (7) consiste en 21 recomendaciones, 9 de ellas para el manejo de pacientes adultos .…”

“…Actualmente, se encuentran en fase de estudio nuevos fármacos como el rozanolixizumab, un anticuerpo monoclonal FcRn antihumano humanizado de alta afinidad. Actúa reduciendo la IgG en (1,7,9,10) plasma, que se cree es uno de los responsables de algunas patologías autoinmunes incluida la PTI .…”

Immune Thrombocytopenia—A Disease or a Group of Disorders? Where Do We Stand in 2019?

“…Mithoowani and Arnold explore common questions about the therapy for ITP. 13 In their article, it becomes evident that the choice of first-line therapy depends primarily on bleeding symptoms and on how quickly a platelet count response is needed. The authors present their approach on fist-line therapy including when to start, which treatment to use, and how to manage bleeding emergencies in ITP.…”