Initial management of immune thrombocytopaenia in adults based on risk stratification

Jaydev Manikkam Umakanthan, Prajwal Dhakal, Krishna Gundabolu, Avyakta Kallam, Daniel R. Almquist, Vijaya Raj Bhatt

Research output: Contribution to journalReview article

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.

Original languageEnglish (US)
Pages (from-to)558-562
Number of pages5
JournalPostgraduate Medical Journal
Volume95
Issue number1128
DOIs
Publication statusPublished - Oct 1 2019

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Keywords

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

ASJC Scopus subject areas

  • Medicine(all)

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