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Blood, 1 October 2005, Vol. 106, No. 7, pp. 2244-2251. Prepublished online as a Blood First Edition Paper on June 7, 2005; DOI 10.1182/blood-2004-12-4598. This Article Full Text (PDF) All Versions of this Article: 2004-12-4598v1 106/7/2244    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Cines, D. Articles by Bussel, J. B Search for Related Content PubMed PubMed Citation Articles by Cines, D. Articles by Bussel, J. B Social Bookmarking                   What's this?  Previous Article  |  Next Article  Submitted December 8, 2004 Accepted April 14, 2005 How I Treat: ITP Douglas Cines* and James B Bussel Departments of Pathology and Laboratory Medicine and Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA Departments of Pediatrics, Medicine and Obstetrics and Gynecology, New York Presbyterian Hospital, Weil Cornell Medical Center, New York, NY, USA * Corresponding author; email: dcines{at}mail.med.upenn.edu. Idiopathic thrombocytopenic purpura (ITP) remains a clinical diagnosis that relies on excluding other causes of thrombocytopenia. There is little evidenced-based data upon which to formulate management decisions. Therefore, this manuscript sets forth an approach to the diagnosis and management of adult patients with ITP based largely on our experience. We emphasize the need for individualization depending on clinical picture and life circumstances. The natural history of ITP is poorly defined, the minimal platelet count required for treatment in the absence of bleeding and for many common surgical procedures is uncertain, and the impact of therapy on long-term outcome is unclear. Increasing numbers of patients are reluctant to undergo splenectomy and prefer to temporize and turn to alternative modalities of treatment. The small proportion of patients with chronic refractory ITP continue to suffer significant morbidity and mortality from bleeding, but also from treatment. Thrombopoietic agents may provide a novel approach to acute and potentially chronic management. More complete outcome data and controlled clinical trials are needed to improve management. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: B. Godeau, R. Porcher, O. Fain, F. Lefrere, P. Fenaux, S. Cheze, A. Vekhoff, M.-P. Chauveheid, J. Stirnemann, L. Galicier, et al. Rituximab efficacy and safety in adult splenectomy candidates with chronic immune thrombocytopenic purpura: results of a prospective multicenter phase 2 study Blood, August 15, 2008; 112(4): 999 - 1004. [Abstract] [Full Text] [PDF] K. M. H. James, C. N. Melikian, P. Chowdary, and S. V. Mallett Thromboelastography-Guided Recombinant Factor VIIa Administration in a Patient with Refractory Autoimmune Idiopathic Thrombocytopenia Anesth. Analg., August 1, 2008; 107(2): 402 - 405. [Abstract] [Full Text] [PDF] W. B. Breunis, E. van Mirre, M. Bruin, J. Geissler, M. de Boer, M. Peters, D. Roos, M. de Haas, H. R. Koene, and T. W. Kuijpers Copy number variation of the activating FCGR2C gene predisposes to idiopathic thrombocytopenic purpura Blood, February 1, 2008; 111(3): 1029 - 1038. [Abstract] [Full Text] [PDF] M. Ruggeri, S. Fortuna, and F. Rodeghiero Heterogeneity of terminology and clinical definitions in adult idiopathic thrombocytopenic purpura: a critical appraisal from a systematic review of the literature Haematologica, January 1, 2008; 93(1): 98 - 103. [Abstract] [Full Text] [PDF] J. B. Bussel, G. Cheng, M. N. Saleh, B. Psaila, L. Kovaleva, B. Meddeb, J. Kloczko, H. Hassani, B. Mayer, N. L. Stone, et al. Eltrombopag for the Treatment of Chronic Idiopathic Thrombocytopenic Purpura N. Engl. J. Med., November 29, 2007; 357(22): 2237 - 2247. [Abstract] [Full Text] [PDF] D. M. Boruchov, S. Gururangan, M. C. Driscoll, and J. B. Bussel Multiagent induction and maintenance therapy for patients with refractory immune thrombocytopenic purpura (ITP) Blood, November 15, 2007; 110(10): 3526 - 3531. [Abstract] [Full Text] [PDF] D. M. Arnold, F. Dentali, M. A. Crowther, R. M. Meyer, R. J. Cook, C. Sigouin, G. A. Fraser, W. Lim, and J. G. Kelton Systematic Review: Efficacy and Safety of Rituximab for Adults with Idiopathic Thrombocytopenic Purpura Ann Intern Med, January 2, 2007; 146(1): 25 - 33. [Abstract] [Full Text] [PDF] J. B. Bussel, D. J. Kuter, J. N. George, R. McMillan, L. M. Aledort, G. T. Conklin, A. E. Lichtin, R. M. Lyons, J. Nieva, J. S. Wasser, et al. AMG 531, a Thrombopoiesis-Stimulating Protein, for Chronic ITP N. Engl. J. Med., October 19, 2006; 355(16): 1672 - 1681. [Abstract] [Full Text] [PDF]

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