DIAGNOSIS AND TREATMENT OF IDIOPATHIC THROMBOCYTOPENIC PURPURA - RECOMMENDATIONS OF THE AMERICAN-SOCIETY-OF-HEMATOLOGY

To develop guidelines for the diagnosis and management of idiopathic t hrombocytopenic purpura (ITP) and to document the extent to which thes e guidelines are based on either scientific evidence or opinion, the A merican Society of Hematology established a panel composed of 13 hemat ologists with expertise in ITP, a clinical epidemiologist, and a pract ice guidelines methodologist. A comprehensive review was done of all p ublished English-language studies that met explicit inclusion criteria and that evaluated the natural history of ITP or the effectiveness of testing and treatment options for ITP. The quality of each study was graded by two reviewers using formal methodologic rules. In subject ar eas for which data were inadequate, recommendations were based on opin ion and were derived by using a formal scoring procedure. Confidential questionnaires were used to survey the hematologists on the panel abo ut the appropriateness of testing and treatment options in hundreds of clinical scenarios. Practice recommendations were derived from the me an appropriateness scores for each indication. Voting was kept confide ntial to give each panel member an equal voice and to limit biases int roduced by group dynamics. The recommendations were peer reviewed by e ight outside experts. This report focuses on data on and recommendatio ns for adults with ITP. Little high-quality scientific evidence with w hich to assess the efficacy of diagnostic tests and treatments for ITP is available. The opinion of the panel was that most diagnostic tests are unnecessary in the routine work-ups of patients suspected of havi ng ITP and that ITP accompanied by severe bleeding requires treatment with glucocorticoids, intravenous immunoglobulin, and other measures. However, treatment and hospitalization are often unnecessary when pati ents have only mild or moderate thrombocytopenia or minimal bleeding. Special therapeutic measures are sometimes indicated in pregnant women with ITP.