Journal Article

Initial Management of Immune Thrombocytopenia in Adults Based on Risk Stratification

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

2019

Overview

Patients with immune thrombocytopenia (ITP) have 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 evidences support 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 needs 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.