DIAGNOSIS AND TREATMENT OF IDIOPATHIC THROMBOCYTOPENIC PURPURA

The American Society of Hematology established a panel to develop prac tice guidelines for the diagnosis and management of idiopathic thrombo cytopenic purpura and to document the extent to which the recommendati ons are based on either scientific evidence or opinion. A comprehensiv e literature review found little high-quality scientific evidence to d efine the natural history of idiopathic thrombocytopenic purpura or to assess the efficacy of diagnostic tests and treatments for the disord er. Recommendations were therefore based on opinion, derived from a fo rmal scoring procedure. In the panel's opinion, in most cases only a h istory, physical examination and complete blood cell count with examin ation 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 thrombocytop enic purpura accompanied by severe bleeding be treated with glucocorti coids, intravenous immunoglobulin and other measures, but that treatme nt and hospitalization are often unnecessary when patients have only m ild to moderate thrombocytopenia or minimal bleeding. Idiopathic throm bocytopenic purpura in pregnant women and the risk of thrombocytopenia in their newborns pose specific problems for diagnosis and treatment.