Diagnosis and treatment of idiopathic thrombocytopenic purpura. American Society of Hematology ITP Practice Guideline Panel

Abstract

The American Society of Hematology established a panel to develop practice guidelines for the diagnosis and management of idiopathic thrombocytopenic purpura and to document the extent to which the recommendations are based on either scientific evidence or opinion. A comprehensive literature review found little high-quality scientific evidence to define the natural history of idiopathic thrombocytopenic purpura or to assess the efficacy of diagnostic tests and treatments for the disorder. Recommendations were therefore based on opinion, derived from a formal scoring procedure. In the panel's opinion, in most cases only a history, physical examination and complete blood cell count with examination of the peripheral blood smear are necessary in the routine work-up of patients with suspected idiopathic thrombocytopenic purpura. The panel suggests different treatment approaches in children and adults because of important differences in the behavior of the disease in the two patient groups. The panel recommends that idiopathic thrombocytopenic purpura accompanied by severe bleeding be treated with glucocorticoids, intravenous immunoglobulin and other measures, but that treatment and hospitalization are often unnecessary when patients have only mild to moderate thrombocytopenia or minimal bleeding. Idiopathic thrombocytopenic purpura in pregnant women and the risk of thrombocytopenia in their newborns pose specific problems for diagnosis and treatment.