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- Title
Management of Primary Immune Thrombocytopenia: Turkish Modified Delphi-Based Consensus Statement for Special Considerations.
- Authors
Ümit, Elif Gülsüm; Demir, Ahmet Muzaffer; Ar, Muhlis Cem; Ayer, Mesut; Aylı, Meltem; Karakuş, Volkan; Kaya, Emin; Özkalemkaş, Fahir; Sayınalp, Nilgün; Sönmez, Mehmet; Şahin, Fahri; Toprak, Selami Koçak; Toptaş, Tayfur; Yavaşoğlu, İrfan; Çalış, Ümran
- Abstract
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 30x109/L and delivery either vaginally or by cesarean section being safe at platelet counts above 50x109/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 >50x109/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.
- Subjects
TURKEY; PUBLIC hospitals; CONSENSUS (Social sciences); CESAREAN section; ADRENOCORTICAL hormones; INTRAVENOUS immunoglobulins; COMBINATION drug therapy; ANTICOAGULANTS; DELIVERY (Obstetrics); VAGINA; PLATELET count; DISEASE management; QUESTIONNAIRES; UNIVERSITIES &; colleges; PHYSICIANS' attitudes; EMERGENCY medical services; HEMATOLOGY; MEDICAL emergencies; DELPHI method; PLATELET aggregation inhibitors; BLOOD transfusion; THROMBOPENIC purpura; HEMORRHAGE; PREGNANCY
- Publication
Turkish Journal of Hematology, 2024, Vol 41, Issue 3, p141
- ISSN
1300-7777
- Publication type
Article
- DOI
10.4274/tjh.galenos.2024.2024.0101