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Advances in Hematology
Volume 2019, Article ID 4621416, 11 pages
https://doi.org/10.1155/2019/4621416
Research Article

Management of Adult Patients with Primary Immune Thrombocytopenia (ITP) in Clinical Practice: A Consensus Approach of the Spanish ITP Expert Group

1Service of Hematology, Hospital Virgen del Rocio, Sevilla, Spain
2Service of Hematology, Hospital Universitario La Paz, Madrid, Spain
3Service of Hematology, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
4Service of Hematology, Hospital Universitario de Burgos, Burgos, Spain
5Service of Hematology and Hemotherapy, Universitario de Araba, Vitoria-Gasteiz, Álava, Spain
6Service of Hematology and Hemotherapy, Hospital Universitario y Politécnico La Fe, Valencia, Spain
7Service of Hematology and Hemotherapy, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
8Department of Hematology and Medical Oncology, Hospital General Universitario Morales Meseguer, IMIB-Arrixaca, CIBERER, Murcia, Spain
9Service of Clinical Hematology, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
10Hematopoietic Stem Cell Transplantation Unit, Hospital Universitario Vall d’Hebron, Barcelona, Spain
11Service of Hematology, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain

Correspondence should be addressed to M. Eva Mingot-Castellano; moc.liamg@tognimem

Received 30 April 2019; Accepted 25 June 2019; Published 22 August 2019

Academic Editor: Shaji Kumar

Copyright © 2019 M. Eva Mingot-Castellano et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background and Objective. Diagnosis and management of primary immune thrombocytopenia (ITP) have changed dramatically in the last decade. The aim of the study was to obtain information about the opinion of the Spanish ITP Group (GEPTI) members regarding the best clinical practices for diagnosis and management of adult patients with ITP. Materials and Methods. A two-round Delphi method was carried out by sending to 129 experts a 90-item questionnaire developed by 11 specialists, with a 4-point Likert scale (“never,” “sometimes,” “frequently,” and “always”) for the assessment of responses. Results. Forty out of the 129 experts participated in the survey (participation rate 30.2%) and 39 completed the questionnaire (response rate 97.5%). Salient consensus points included the following: the need to indicate workup studies from a sustained platelet count < 100 x 109/L in the absence of a clear etiology; bone marrow aspiration in elderly patients with suspected ITP; beginning treatment in asymptomatic patients with a platelet count < 20 x 109/L; not exceeding 6-7 weeks of corticosteroid therapy; switching from corticosteroids to one thrombopoietin receptor agonist (TRA); switching to other TRA or other options as combinations of them with immunosuppressive drugs in case of failure; how to reduce tapering TRA; treating patients with symptomatic persistent ITP and platelet count > 20 x 109/L; and considering mucosal or severe bleeding as a basic criterion for hospital admission. Conclusions. The present consensus document provides a reference framework for the management of patients with ITP in clinical practice.