Management of Primary Immune Thrombocytopenia: Turkish Modified Delphi-Based Consensus Statement for Special Considerations

Autor:	Ümit EG; Trakya University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Edirne, Türkiye, Demir AM; Trakya University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Edirne, Türkiye, Ar MC; İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Türkiye, Ayer M; University of Health Sciences Türkiye, Başakşehir Çam and Sakura City Hospital, Clinic of Hematology, İstanbul, Türkiye, Aylı M; University of Health Sciences Türkiye, Gülhane Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye, Karakuş V; University of Health Sciences Türkiye, Antalya Training and Research Hospital, Clinic of Hematology, Antalya, Türkiye, Kaya E; İnönü University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Malatya, Türkiye, Özkalemkaş F; Bursa Uludağ University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Bursa, Türkiye, Sayınalp N; Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye, Sönmez M; Karadeniz Technical University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Trabzon, Türkiye, Şahin F; Ege University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Türkiye, Toprak SK; Ankara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye, Toptaş T; Marmara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Türkiye, Yavaşoğlu İ; Aydın Adnan Menderes University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Aydın, Türkiye, Çalış Ü; Abdi İbrahim İlaç Sanayi ve Tic. A.Ş., Senior Medical Manager, İstanbul, Türkiye
Jazyk:	angličtina
Zdroj:	Turkish journal of haematology : official journal of Turkish Society of Haematology [Turk J Haematol] 2024 Aug 28; Vol. 41 (3), pp. 141-145. Date of Electronic Publication: 2024 May 27.
DOI:	10.4274/tjh.galenos.2024.2024.0101
Abstrakt:	Objective: Primary immune thrombocytopenia (ITP) is an acquired disorder of platelets with a complex and unclear mechanism of increased immune destruction or impaired production of platelets. While the management of ITP is evolving, there is still a need for guidance, particularly in certain circumstances such as pregnancy, emergencies, or patients requiring co-medications. We aimed to determine the tendencies of hematologists in Türkiye in the event of such special considerations. Materials and Methods: Applying a modified Delphi method, the Turkish National ITP Working Group, founded under the auspices of the Turkish Society of Hematology, developed a questionnaire consisting of statements regarding pregnancy, emergencies, and circumstances requiring co-treatment with antiaggregants or anticoagulants. A total of 107 hematologists working in university or state hospitals voted for their agreement or disagreement with the statements for two sequential rounds. Results: The participating hematologists reached an agreement on starting treatment for pregnant patients with platelets of less than 30x10 9 /L and delivery either vaginally or by cesarean section being safe at platelet counts above 50x10 9 /L. For emergencies and the rescue management of ITP, the panel agreed against the use of high-dose corticosteroids alone, preferring combinations with transfusions or intravenous immunoglobulin. For patients who require interventions, platelet counts of >50x10 9 /L were regarded as safe for low-risk procedures as well as co-treatment with antiplatelets or anticoagulants. Conclusion: As the National ITP Study Group, we have observed the need to increase the practice guidance regarding patients with primary ITP requiring additional treatments including invasive interventions and co-treatments for coagulation. Decisions on the management of ITP during pregnancy should be individualized. There is a lack of consensus on the thresholds of platelet counts as well as co-morbidities and co-medications. This lack of consensus may be due to variations in practices. Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors. (©Copyright 2024 by Turkish Society of Hematology Turkish Journal of Hematology, Published by Galenos Publishing House.)
Databáze:	MEDLINE
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