Materiały źródłowe

• #1 Immune Thrombocytopenia (ITP): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/202158-overview

  Immune thrombocytopenia (ITP) is a syndrome in which platelets become coated with autoantibodies to platelet membrane antigens, resulting in splenic sequestration and phagocytosis by mononuclear macrophages. The resulting shortened life span of platelets in the circulation, together with incomplete compensation by increased platelet production by bone marrow megakaryocytes, results in a decreased number of circulating platelets (thrombocytopenia; see the image below). […] ITP manifests as a bleeding tendency, easy bruising (purpura), or extravasation of blood from capillaries into skin and mucous membranes (petechiae). […] An initial impression of the severity of ITP is formed by examining the skin and mucous membranes, as follows: Widespread petechiae and ecchymoses, oozing from a venipuncture site, gingival bleeding, and hemorrhagic bullae indicate that the patient is at risk for a serious bleeding complication.

• #2 Immune Thrombocytopenia (ITP) | University Hospitals

  https://www.uhhospitals.org/services/cancer-services/benign-hematologic-disorders/disorders-we-treat/immune-thrombocytopenia

  Immune thrombocytopenia (ITP) is when the bodys immune system attacks and destroys platelets, the blood cells that cause blood clots to form and help control bleeding. […] The immune system produces antibodies that attach to the platelets and destroy them. […] This results in a low platelet count, causing easy bruising and internal bleeding, which can be seen as blood blisters in the mucous membranes and purple areas that look like black-and-blue marks on the skin and the outer linings of the organs. […] ITP has no cure, so medical care for ITP focuses on increasing the platelet count to a safe level to prevent severe bleeding. Many patients will go into remission spontaneously or with treatment. […] Corticosteroids such as prednisone or dexamethasone are often prescribed, and can help increase platelet count. In addition, blood platelet transfusions may be necessary to raise the platelet count. […] If initial treatment is not successful, second-line therapies include: Anti-RhoD an intravenous drug infusion to elevate platelet counts, Chemotherapy, Immunosuppressants, Androgens.

• #3 Presentation, Diagnosis, and Nursing Management

  https://www.theoncologynurse.com/itp

  Idiopathic thrombocytopenic purpura (ITP), now more commonly referred to as immune thrombocytopenia, is defined as a hemorrhagic disorder in which there is a pronounced reduction in circulating blood platelets due to the presence in blood plasma of a substance that agglutinates platelets. […] Nursing Management of the Patient With ITP Although thrombocytopenia is associated with increased bleeding, it is not uncommon for patients with ITP to have no bleeding despite platelet counts 20,000. Frequently, patients with ITP are followed by hematology specialists and cared for by oncology nurses. It is important to recognize that platelet transfusion remains the primary method for managing active, life-threatening bleeding. However, transfusing platelets without evidence of bleeding is not encouraged. Patients with ITP should be assessed for bleeding at each clinic visit. Proper assessment of the patient includes a thorough history and physical. Historical reports of bleeding episodes can help guide future preventive measures and avoid significant morbidity. A patient with a history of peptic ulcer disease should take preventive medications to prevent recurrence of this disease in the presence of thrombocytopenia. Patient education and management should include avoiding over-the-counter medications that could interfere with hemostasis.

• #4 Idiopathic Thrombocytopenic Purpura (ITP): Symptoms and Diagnosis

  https://www.healthline.com/health/idiopathic-thrombocytopenic-purpura-itp

  ITP, or immune thrombocytopenia, is a blood clotting disorder caused by a low number of platelets. It can be either acute or chronic but is rarely life threatening. Most cases are treatable with medication. […] Because of their low platelet count, people with ITP often have many purple bruises called purpura on their skin or inside their mouth. These bruises may also appear as pinpoint-sized red or purple dots, kind of like a rash, on the skin, that are called petechiae. On darker skin tones, they may appear dark brown or black. […] If you or your child requires treatment, your doctor will likely prescribe medications as the first course of treatment. The most common medications used to treat ITP include: […] Your doctor may also advise you to make some lifestyle changes, including: avoiding the blood-thinning medication warfarin (Coumadin) and certain over-the-counter drugs that can affect platelet function like aspirin and ibuprofen (Advil, Motrin).

• #5 Thrombocytopenia: Nursing Diagnoses & Care Plans | NurseTogether

  https://www.nursetogether.com/thrombocytopenia-nursing-diagnosis-care-plan/

  Immune thrombocytopenia (ITP) is the most common acquired thrombocytopenia and is characterized by the irregular destruction of platelets, often related to autoimmune diseases that cause the body to destroy its own platelets. […] Nursing care for patients diagnosed with thrombocytopenia will mainly depend on the cause of the condition. In some cases, treating the underlying disorder may be sufficient to manage low platelets. Nurses are primarily responsible for preventing bleeding, the early recognition of signs of bleeding, and prompt intervention for its management. Patient education regarding their disease process, prompt reporting of complications, and how to reduce the risk of bleeding is essential. […] The removal of the spleen may be required for immune thrombocytopenia (ITP) or when other treatments have failed. The spleen plays a role in immune function, so the patient will need to take extra precautions to prevent infections.

• #6 Diagnosis, Treatment, and Management of Immune Thrombocytopenia | Oncology Nursing Society

  https://www.ons.org/publications-research/cjon/17/6/diagnosis-treatment-and-management-immune-thrombocytopenia

  Management of immune thrombocytopenia (ITP) requires accurate assessment and evaluation, appropriate treatment strategies, and timely nursing interventions (e.g., monitoring, bleeding prevention, patient education). […] The overview of ITP in the current article reviews its etiology and provides updates about medical management and key components of nursing care.

• #7 Nursing Care Plan For Idiopathic Thrombotic Purpura – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-idiopathic-thrombotic-purpura/

  By actively engaging in assessments, education, and support, nurses contribute significantly to the well-being and resilience of individuals affected by idiopathic thrombotic purpura. The care plan seeks to address both the immediate and ongoing needs of patients, fostering a collaborative and patient-centered approach to hematological health. […] This comprehensive nursing assessment forms the foundation for developing an individualized care plan for ITP, guiding interventions to prevent bleeding complications, optimize platelet levels, and enhance the patients overall quality of life. Regular reassessment is crucial to adapt interventions based on the patients response and the evolving nature of the condition. […] These nursing diagnoses provide a foundation for developing a comprehensive care plan for individuals with ITP. Regular reassessment and collaboration with the healthcare team are essential to tailor interventions to the evolving needs of the patient.

• #8 Nursing Care Plan For Idiopathic Thrombotic Purpura – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-idiopathic-thrombotic-purpura/

  These nursing interventions aim to optimize the care of individuals with ITP by preventing bleeding complications, enhancing emotional well-being, and promoting overall health. Regular reassessment and collaboration with the healthcare team are crucial to adapt interventions based on the patients response and the evolving nature of the condition. […] The care plan encompasses a range of nursing diagnoses and interventions, addressing the risk for bleeding, impaired skin integrity, anxiety, infection prevention, deficient knowledge, impaired physical mobility, altered nutrition, and impaired coping. […] Through effective collaboration with the healthcare team, patients, and families, nurses play a pivotal role in promoting optimal living and psychosocial well-being for individuals affected by idiopathic thrombotic purpura.

• #9 Nursing Interventions for Thrombocytopenia – Pathophysiology

  https://www.naxlex.com/nursing/study-guides/nursing-interventions-for-thrombocytopenia-1697448151

  – The nursing interventions for thrombocytopenia are aimed at preventing and managing bleeding complications; administering medications and transfusions as ordered; monitoring the patients response to treatment; and providing emotional support and education to the patient and family. […] – Assess for signs of bleeding […] – Administer corticosteroids, IVIG, anti-D antibody, or rituximab as prescribed […] – Prepare the patient for splenectomy if indicated […] – Teach the patient to avoid NSAIDs, aspirin, and alcohol […] – Monitor for signs of bleeding […] – Educate the patient on infection prevention […] – A nurse is caring for a patient with thrombocytopenia. […] – A nurse is assessing a patient with thrombocytopenia. Which interventions are appropriate for this patient? Select all that apply.

• #10 Immune Thrombocytopenia (ITP) – Seattle Children’s

  https://www.seattlechildrens.org/conditions/itp/

  We help you and your child lower the risk of bleeding problems. […] Steroids (such as prednisone or dexamethasone) decrease antibody production and may help slow down how fast the spleen removes platelets from the blood. […] Immunoglobulin (IVIG) contains many proteins that fight infection (antibodies). It may help block the antibodies that destroy platelets. […] If your child’s ITP is severe and medicine is not working, the doctor may recommend removing your child’s spleen. This is called splenectomy. […] We usually check your child’s platelet count at each clinic visit. A normal platelet count is above 100,000. […] Our experience helps us know when your child does need treatment and which treatment is best for them. […] We keep a careful watch on your child’s health. We recommend the right treatment at the right time to have the best results for your child and your family. […] Although ITP is mild in some children, other kids have serious bleeding problems. We will see your child in our clinic or emergency department that same day if they have signs of active bleeding, such as a nosebleed lasting longer than 5 minutes.

• #10 Immune Thrombocytopenia (ITP) – Seattle Children’s

  https://www.seattlechildrens.org/conditions/itp/

  Children with ITP can lead active, normal lives. Many children do not need treatment. ITP often goes away on its own in a few weeks or months. […] We watch your child closely and recommend the best treatments for them. Treatment does not cure ITP, but it will often increase the number of platelets. Most treatments slow down the loss of platelets. A few treatments help your child make more platelets. […] Often, children who need medicine or blood products into their vein (infusion) can get care without having to spend a night in the hospital. Our outpatient infusion unit is staffed by expert nurses and is open every day. […] If your child does not have serious bleeding symptoms, we usually recommend watchful waiting. This means we regularly check your child for symptoms of active bleeding and provide treatment if needed.

• #11 Discharge Instructions for Immune Thrombocytopenia (ITP)

  https://umcno.staywellsolutionsonline.com/Library/Wellness/Behavior/3,86388

  Warfarin […] Dont take any other medicine without checking with your provider first. This includes prescription and over-the-counter medicines, herbs, vitamins, and other supplements. […] Take all medicines exactly as directed. […] Limit your alcohol intake. Alcohol can make it harder for your blood to clot and put you at risk for accidents. […] Keep all follow-up appointments. Your provider will need to check your blood platelet count closely. […] Tell your dentist or other health care providers that you have ITP before any procedures. […] Lower your risk of bleeding […] Recommendations to lower your risk include: […] Talk with your health care provider before playing any sports, especially contact sports, or activities that carry a risk for injury. […] Do what you can to prevent bruising, bumping, or cutting yourself.

• #12 Nursing Interventions for Thrombocytopenia – Pathophysiology

  https://www.naxlex.com/nursing/study-guides/nursing-interventions-for-thrombocytopenia-1697448151

  – Administer platelet transfusions for life-threatening hemorrhage. […] – Teach the patient to avoid NSAIDs, aspirin, and alcohol. […] – Administer corticosteroids, IVIG, anti-D antibody, or rituximab as prescribed. […] – A client with thrombocytopenia is at risk of bleeding complications. Which nursing intervention is essential to prevent and manage bleeding in this client? […] – Applying pressure to any bleeding site and elevating the affected area. […] – A nurse is caring for a patient diagnosed with thrombocytopenia. What should the nurse include in the patient education regarding self-care measures? […] – Teach the patient to avoid alcohol and aspirin.

• #13 Immune Thrombocytopenia | Doctor

  https://patient.info/doctor/immune-thrombocytopenia-pro

  General measures include stopping medication which has an effect on platelet function (eg, NSAIDs), control of blood pressure, inhibition of menses, and avoidance of trauma. […] Any of the following may be used in a specialist setting if it is thought that the clinical condition requires that the platelet count should be raised: Prednisolone, Intravenous immunoglobulin, Intravenous anti-D immunoglobulin (in rhesus-positive children). […] Splenectomy is rarely indicated in childhood ITP and is only used in the event of life-threatening bleeding, or in children with severe, chronic, unremitting ITP present for 12-24 months with severe symptoms. In adults it is sometimes offered as a second or third-line treatment option.

• #14 Immune Thrombocytopenic Purpura – Stanford Medicine Children’s Health

  https://www.stanfordchildrens.org/en/topic/default?id=immune-thrombocytopenic-purpura-85-P00096

  ITP is a blood disorder. With this disease, you have a lower amount of platelets than normal in your blood. A decrease in platelets can result in easy bruising, bleeding gums, and internal bleeding. Treatment options include medicines that can reduce platelet destruction, or help the body make more platelets. When treatment is needed, the 2 most common forms of immediate treatment are steroids and intravenous immunoglobulin (IVIG): Steroids. These medicines help prevent bleeding by slowing down platelet destruction. They can lead to a higher platelet count in 2 to 3 weeks. Intravenous immunoglobulin (IVIG) is made of antibodies removed from blood donations from thousands of healthy donors. IVIG helps by increasing your platelet count. You may see a response in as little as 24 to 48 hours. Other treatments for ITP may include: Rh immune globulin. This medicine briefly stops the spleen from destroying platelets. You must be Rh positive and have a spleen for this medicine to work. Surgery to remove the spleen (splenectomy). The spleen makes antibodies that help fight infections. When you have ITP, these antibodies destroy platelets by mistake. This surgery is done more often in people with chronic ITP to slow down platelet destruction. […] ITP may happen suddenly and go away in about 6 months. Or it may be ongoing (chronic) and last for years. In some cases, surgery to remove the spleen is needed.

• #15 Living with ITP | PDSA

  https://pdsa.org/living-with-itp

  Caregivers can get helpful support and guidance from PDSA experts and the following national organizations: Caregiver Action Network, Lotsa Helping Hands. […] Corticosteroids, such as prednisone can have damaging effects and cause many problems for people with ITP. […] However, there are things you can do to lessen side effects including weight gain, muscle loss, bone loss and mood swings associated with prednisone use.

• #16 Immune Thrombocytopenia (ITP) Treatment & Management: Approach Considerations, Thrombopoietin Receptor Agonists, Treatment in Children

  https://emedicine.medscape.com/article/202158-treatment

  TPO-RA and rituximab are second-line options for patients with ITP lasting 3 months or more and in those who are corticosteroid dependent or have no response to corticosteroids. […] Splenectomy is an option for chronic ITP, as it is associated with long-term treatment-free remissions, but it is very rarely indicated in pediatric patients. […] For pediatric patients requiring treatment, ASH suggests a short course of corticosteroids for first-line treatment rather than IVIG or anti-D immunoglobulin. […] For children or adolescents with ITP who have significant ongoing bleeding despite treatment with IVIG, RhIG, or conventional doses of corticosteroids, ASH suggests a TPO-RA rather than rituximab or splenectomy as second-line treatment. […] In adults, treatment is recommended for a platelet count 30 109/L. The ASH recommends that if treatment is needed, shorter courses of corticosteroids (6 weeks) are preferred over prolonged courses as first-line treatment.

• #17 Nursing Interventions for Thrombocytopenia – Pathophysiology

  https://www.naxlex.com/nursing/study-guides/nursing-interventions-for-thrombocytopenia-1697448151

  – Administer platelet transfusion. […] – Monitor for signs of bleeding. […] – Educate the patient on infection prevention. […] – A nurse is caring for a patient with thrombocytopenia. The patient presents with mucosal bleeding, including petechiae, purpura, and gingival bleeding. What should the nurse anticipate when assessing this patient’s platelet count? […] – The platelet count may be below 50,000/uL, indicating a risk of prolonged bleeding. […] – A client with thrombocytopenia experiences prolonged bleeding even after minor trauma. What statement by the nurse accurately explains the relationship between platelet count and bleeding risk? […] – A platelet count below 50,000/uL can result in prolonged bleeding. […] – A nurse is providing care to a patient with thrombocytopenia. Which nursing interventions are appropriate for this patient? Select all that apply.

• #18 Presentation, Diagnosis, and Nursing Management

  https://www.theoncologynurse.com/itp

  Patient understanding of the treatment regimen, including dosing and timing of medications, is essential to successful management. Providing verbal and written instructions regarding medications and regimens decreases confusion and improves patient adherence to the overall treatment plan. […] It is essential that patients be given the information and tools to ameliorate their risk of bleeding while undergoing treatment. Nurses spend the most time with patients overall and are in the best position to reinforce the treatment plan to ensure the best outcome. Patients are required to master complex drug therapy and treatment schedules; thus, one of the best tools to give them at their first visit is access to care. Providing a telephone number where a healthcare professional can be reached for questions, concerns, or emergencies is essential to prevent significant morbidity and mortality.

• #19 Discharge Instructions for Immune Thrombocytopenia (ITP)

  https://umcno.staywellsolutionsonline.com/Library/Wellness/Behavior/3,86388

  Bleed for no clear reason, or you have heavy bleeding or bleeding that lasts longer than normal. […] Have tiny areas of pinpoint bleeding on (or just under) the skin of the arms or legs. […] Have blood in your urine or stool. […] Bleed from your nose or gums. […] Have heavier than normal menstrual bleeding. […] Have a head injury or any major injury. […] Have headaches, confusion, or changes in your vision.

• #20 Discharge Instructions for Immune Thrombocytopenia (ITP)

  https://umcno.staywellsolutionsonline.com/Library/Wellness/Behavior/3,86388

  Discharge Instructions for Immune Thrombocytopenia (ITP) […] Your health care provider has diagnosed you with immune thrombocytopenia (ITP). ITP has also been called immune thrombocytopenic purpura and idiopathic thrombocytopenic purpura. ITP is a bleeding disorder that causes your immune system to destroy your platelets. Platelets are cells that help stop bleeding. If your body doesn’t have enough platelets, your risk of bleeding goes up. Here’s what you can do at home to lower your risk. […] Medicine and medical care […] Here are tips to follow: […] Talk with your health care provider about which medicines you should not take. Don’t take the following medicines, unless directed to by your provider. They make it harder for your blood to clot: […] Aspirin […] Ibuprofen or other NSAIDs (nonsteroidal anti-inflammatory drugs)

• #21 Immune thrombocytopenia (ITP)

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20166974

  If you have immune thrombocytopenia, try to: Avoid contact sports. Getting hit in the head during sports like boxing, martial arts and football could cause bleeding in the brain. […] Diagnosing immune thrombocytopenia usually involves more blood tests. Your provider might send you to a specialist in blood diseases, also known as a hematologist.

• #22 Discharge Instructions for Immune Thrombocytopenia (ITP)

  https://umcno.staywellsolutionsonline.com/Library/Wellness/Behavior/3,86388

  Use an electric razor when shaving. Be careful when using sharp items such as nail trimmers or knives. […] Blow your nose very gently to prevent nosebleeds. […] Use a cool steam vaporizer to keep the air inside your home moist enough to prevent nosebleeds. […] Wear hard-soled shoes when outside. […] Use gloves and wear long pants when gardening or doing other activities where your skin could get scratched. […] If you have problems with gum bleeding, use a sponge toothbrush (instead of one with bristles). Ask your healthcare provider or dentist where you can get one. […] Follow-up […] Make a follow-up appointment as directed by our staff. […] When to call your health care provider […] Call your health care provider right away if you: […] Bruise easily.

• #23 Chronic Immune Thrombocytopenia (ITP)

  https://www.webmd.com/a-to-z-guides/chronic-immune-thrombocytopenia

  If medicine doesn’t improve your platelet count, you might need surgery to remove your spleen, called a splenectomy. […] ITP can be with you for many years. You may need to take medicine long-term to keep up your platelet count. […] Life with a rare chronic condition can be very stressful. Mind-body techniques like meditation, yoga, or guided imagery can help you relax. […] When you need extra help, turn to family, friends, and your treatment team. You can also get help from the Platelet Disorder Support Association (PDSA). […] An ITP diagnosis could make you wonder about your future. Will this disease be with you for a lifetime? […] There is no cure for ITP. But corticosteroids and other medicines increase platelet counts and improve symptoms in most people. […] Chronic ITP can last for many years, and you may have to stay on treatment for the long term to prevent complications like severe bleeding.

• #24 Living with ITP | PDSA

  https://pdsa.org/living-with-itp

  Just as its name is difficult to pronounce, immune thrombocytopenia (ITP) can be even harder to live with. […] ITP can affect both children and adults. And, those living with ITP experience a roller coaster of physical and emotional challenges as they try to monitor platelet counts, balance treatment side effects and manage the fear and reality of relapse. […] The good news is there are steps you can take to help minimize some of the most common challenges ITP presents and improve your overall quality of life. […] A big part of feeling better with ITP is having a caregiver who cares. But, caregivers need attention, too. Caregiver burnout is real and can lead to chronic stress, fatigue, insomnia, anxiety, depression, addiction and chronic health issues including heart disease, Type 2 diabetes and stroke.

• #25 Immune Thrombocytopenia (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/immune-thrombocytopenia.html

  Immune thrombocytopenia happens when the immune system, which fights germs and infections, attacks the body’s platelets. […] Treating immune thrombocytopenia depends on how severe the symptoms are. Children who only have bruising and red pinpoint spots may not need any treatment. […] When needed, treatments may include: medicines that stop the immune system from attacking platelets, such as: steroids, an IV injection of antibodies (immunoglobulins or rituximab). […] While they have immune thrombocytopenia, kids need to avoid sports and activities (such as bike riding and contact sports) that could lead to injury and bleeding. […] Most children with immune thrombocytopenia recover fully within a few months. Help your child by going to all doctor’s appointments, following the doctor’s advice on which activities are OK and which to avoid.

• #26 Immune Thrombocytopenia and Child Care or School Attendance

  https://healthhub.cpcmg.net/docs/immune-thrombocytopenia-and-child-care-or-school-attendance

  Immune thrombocytopenia (previously known as idiopathic thrombocytopenia purpura [ITP]) is a bleeding disorder caused by having too few platelets in the blood. Platelets are small cells in the blood that help form blood clots, which stop bleeding. […] Immune thrombocytopenia must be distinguished from more serious conditions. It is more likely to develop in a child while he or she is in child care or school than to be a preexisting condition. […] In mild cases, no medications are required. […] Sometimes, ITP is treated with immune therapy or corticosteroids. […] Schedule a visit with parents/guardians before their child returns to the school or program to review specifics of their child’s condition. […] Have the child avoid contact sports and activities that could cause head trauma, and limit climbing. A child with ITP may need to stay home until the condition is under control. […] Call emergency medical services (911) for uncontrolled bleeding, including a nosebleed that doesn’t stop after 15 minutes. […] First aid to stop bleeding […] Standard injury precautions […] Background about ITP.

• #27 Immune thrombocytopenia (ITP) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/idiopathic-thrombocytopenic-purpura/diagnosis-treatment/drc-20352330

  Our caring team of Mayo Clinic experts can help you with your Immune thrombocytopenia (ITP)-related health concerns […] People with mild immune thrombocytopenia might need only regular platelet checks. […] Most adults with ITP will need treatment at some point. […] Treatment might include medicines to increase platelet count or surgery to remove the spleen, known as a splenectomy. […] A health care provider can talk about the pros and cons of treatment options. […] If medicine doesn’t make ITP better, surgery to remove the spleen might be the next step. […] When it works, this surgery quickly ends the attacks on platelets and improves platelet count. […] But taking out the spleen doesn’t work for everyone. […] Rarely, ITP can cause a lot of bleeding. Emergency care usually includes getting blood, also known as transfusion, that contains many platelets. […] If you’ve had your spleen removed, look for signs of infection, including fever. […] Medicines such as aspirin and ibuprofen (Advil, Motrin IB, others) can increase bleeding risk.

• #28 Immune Thrombocytopenia | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/immune-thrombocytopenia

  In addition, individuals with ITP may need to make lifestyle changes, including: Limiting participation in contact sports, such as football, boxing and martial arts, and other sports that can increase the risk of head injury, including skiing, snowboarding and motorbike racing. […] Patients who have undergone splenectomy must have non-expired antibiotics at home in case they develop signs or symptoms of an infection, such as a fever and greenish mucus. Patients experiencing these symptoms must notify their doctor to receive instructions on whether or not to take antibiotics. […] Avoiding over-the-counter, herbal or prescription medications that can decrease the function of platelets. These include, but are not limited to, aspirin, ibuprofen, naproxen and Coumadin.

• #29 How we treat primary immune thrombocytopenia in adults | Journal of Hematology & Oncology | Full Text

  https://jhoonline.biomedcentral.com/articles/10.1186/s13045-023-01401-z

  Splenectomy remains the most effective therapy for corticosteroid-resistant or relapsed ITP patients by removing the major site of platelet phagocytosis and autoantibody production. […] There is also evidence that even though CR was not achieved after splenectomy, most patients displayed a milder course of the disease and responded better to medical treatment. […] The necessity for antibiotic prophylaxis in splenectomized ITP patients is still undetermined, and we suggest antibiotic prophylaxis in high-risk patients, such as immunocompromised cases, or those with a poor response to vaccination.

• #30

  https://haematologica.org/article/view/haematol.2021.279513

  This article summarizes our approach to the diagnosis of immune thrombocytopenia (ITP), its secondary forms, and choice of second-line treatment options. […] The management of ITP becomes more complicated if other findings arise, if patients do not respond to steroids, or if patients continue to require treatment. […] Compliance with this strong recommendation entails earlier use of second-line therapy in patients with ITP, a practice already gaining traction. […] This review focuses on the initiation of second-line treatment reviewing the pros and cons of different agents utilizing a case-based approach by first exploring ITP in a young female and continuing throughout her pregnancy. […] The standard treatments for ITP during pregnancy are steroids and IVIG (Table 3) which are the most widely used and felt to be the safest.

• #31

  https://haematologica.org/article/view/haematol.2021.279513

  The prednis(ol)one recommendation for ITP in pregnancy, because of the limited duration of anticipated treatment, is relatively low-dose prednisone (e.g., 10-20 mg daily) based on targeting a platelet threshold of 20-30×109/L. […] If treatment with rituximab is delayed too long in this woman, the chance of cure may be reduced. […] If the platelet count goes very high (with any of the 3 TPO-RA), do not withhold the dose, but decrease it by 1 mg/kg (or equivalent); several days of aspirin can be given if there is concern of thrombosis. […] Splenectomy is used even less in this age group, since efficacy is lower, and the risk of side effects is higher. […] The primary advantages remain the high response rate and the low likelihood that there will be major side effects although venous and arterial thrombosis would be the primary concerns in this older man. […] With many second-line agents, there are various treatment options and courses depending on individual responses, relapses and potential complications with each agent, as demonstrated in Figure 2.

• #32 Immune Thrombocytopenia (ITP) Treatment & Management: Approach Considerations, Thrombopoietin Receptor Agonists, Treatment in Children

  https://emedicine.medscape.com/article/202158-treatment

  In adults with ITP lasting 3 months who are corticosteroid-dependent or have no response to corticosteroids, the ASH guidelines suggest either splenectomy or a TPO-RA. […] Fostamatinib (Tavalisse) was approved by the US Food and Drug Administration (FDA) in 2018 for thrombocytopenia in adults with chronic ITP who have had an insufficient response to a previous treatment. […] Pregnant women with no bleeding manifestations whose platelet counts are 30 109/L or higher do not require any treatment until 36 weeks’ gestation, unless delivery is imminent. […] In persons with acute immune thrombocytopenia (ITP), splenectomy usually results in rapid, complete, and life-long clinical remission.

• #33 Living with Immune Thrombocytopenia | Hematology-Oncology Associates of CNY

  https://www.hoacny.com/patient-resources/blood-disorders/immune-thrombocytopenia/living-immune-thrombocytopenia

  Treatment for ITP during pregnancy depends on a woman’s platelet count. If treatment is needed, the doctor will take a close look at the possible effects of the treatment on the unborn baby. […] Pregnant women who have very low platelet counts or a lot of bleeding are more likely to have heavy bleeding during delivery or afterward. To prevent heavy bleeding, these women usually are treated.

• #34 Second-Line Treatment of Persistent Immune Thrombocytopenia – Hematology Advisor

  https://www.hematologyadvisor.com/cch/second-line-treatment-persistent-immune-thrombocytopenia/

  Consider second-line therapy in adults with ITP lasting 3 months or longer who are corticosteroid dependent or have no response to corticosteroids and adults who have had ITP for 12 months. TPO-RAs are the preferred second-line therapy over splenectomy and rituximab. Some exceptions to receiving TPO-RAs include: Patients who prefer to avoid long-term medication may prefer splenectomy or rituximab; Patients who wish to avoid surgery may prefer a TPO-RA or rituximab; and Patients who place a high value on achieving a durable response may prefer splenectomy or TPO-RAs. […] For most pregnancies, a platelet count of 20 to 30 109/L in a nonbleeding patient is safe; a platelet count of 50 109/L or higher is preferred for delivery. Rituximab can be considered in pregnancy in very severe cases. Monitoring for perinatal and neonatal immunosuppression and subsequent infection is recommended. TPO-RAs may be considered in late pregnancy when other treatments have failed but published data are limited.

• #35 Discharge Instructions for Immune Thrombocytopenia (ITP) | UMass Memorial Health

  https://www.ummhealth.org/health-library/discharge-instructions-for-immune-thrombocytopenia-itp

  Your health care provider has diagnosed you with immune thrombocytopenia (ITP). ITP is a blood disorder that causes your immune system to destroy your platelets. Here’s what you can do at home to lower your risk. […] ITP is a bleeding disorder that causes your immune system to destroy your platelets. Platelets are cells that help stop bleeding. If your body doesn’t have enough platelets, your risk of bleeding goes up. Here’s what you can do at home to lower your risk. […] Talk with your health care provider about which medicines you should not take. Don’t take the following medicines, unless directed to by your provider. They make it harder for your blood to clot: Aspirin, Ibuprofen or other NSAIDs (nonsteroidal anti-inflammatory drugs), Warfarin. […] Don’t take any other medicine without checking with your provider first. This includes prescription and over-the-counter medicines, herbs, vitamins, and other supplements.

• #36 Discharge Instructions for Immune Thrombocytopenia (ITP) | UMass Memorial Health

  https://www.ummhealth.org/health-library/discharge-instructions-for-immune-thrombocytopenia-itp

  Take all medicines exactly as directed. […] Limit your alcohol intake. Alcohol can make it harder for your blood to clot and put you at risk for accidents. […] Keep all follow-up appointments. Your provider will need to check your blood platelet count closely. […] Tell your dentist or other health care providers that you have ITP before any procedures. […] Recommendations to lower your risk include: Talk with your health care provider before playing any sports, especially contact sports, or activities that carry a risk for injury. […] Do what you can to prevent bruising, bumping, or cutting yourself. […] Use an electric razor when shaving. Be careful when using sharp items such as nail trimmers or knives. […] Blow your nose very gently to prevent nosebleeds. […] Use a cool steam vaporizer to keep the air inside your home moist enough to prevent nosebleeds.

• #37 Discharge Instructions for Immune Thrombocytopenia (ITP) | UMass Memorial Health

  https://www.ummhealth.org/health-library/discharge-instructions-for-immune-thrombocytopenia-itp

  Wear hard-soled shoes when outside. […] Use gloves and wear long pants when gardening or doing other activities where your skin could get scratched. […] If you have problems with gum bleeding, use a sponge toothbrush (instead of one with bristles). Ask your healthcare provider or dentist where you can get one. […] Make a follow-up appointment as directed by our staff. […] Call your health care provider right away if you: Bruise easily. […] Bleed for no clear reason, or you have heavy bleeding or bleeding that lasts longer than normal. […] Have tiny areas of pinpoint bleeding on (or just under) the skin of the arms or legs. […] Have blood in your urine or stool. […] Bleed from your nose or gums. […] Have heavier than normal menstrual bleeding. […] Have a head injury or any major injury. […] Have headaches, confusion, or changes in your vision.

• #38 Self-Care for ITP

  https://www.everydayhealth.com/immune-thrombocytopenia/itp-self-care-tips/

  Medications like aspirin or ibuprofen, and some supplements like fish oil, alter the way platelets work, says Tellez. […] While you might prefer to keep your ITP to yourself, doing so may jeopardize your health in certain situations, says Tellez. […] Consistently getting a good nights sleep helps ensure your immune system is running as smoothly as possible. […] Poor sleep quality because of hypersomnia was a problem for one-third of patients with ITP participating in a survey. […] If we lived in a bubble, wed probably be better off in terms of acute risk, Tellez notes. […] You should feel free to participate in most games and activities with friends, says Tellez, but you may need to modify or opt out of higher-risk choices. […] Connecting with other people online or in a local support group can help you learn what to expect with ITP, but its important to make sure that any online forums you visit are moderated and supply accurate information. […] To get a good grasp of how to manage ITP, you should read up on the disorder.

• #39 Self-Care for ITP

  https://www.everydayhealth.com/immune-thrombocytopenia/itp-self-care-tips/

  The key issue is to be prepared for when a bleeding episode happens, says Dr. Tellez, since its inevitable that youll injure yourself and bleed at some point. […] While some people with ITP are at high risk for bleeding and will need to follow stricter precautions for injuries, such as topical or oral medications, most people who have ITP can treat minor cuts in the usual manner, says Tellez. […] Other than contact sports, most forms of physical activity are safe for the majority of people who have ITP, says Tellez. […] You want to have good communication between your brain and your body to promote coordination and avoid injury, she notes. […] When you have ITP, its important to avoid ingesting anything food, drugs, and any vitamins or supplements that could interfere with your bloods ability to clot.

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