Most interesting thing in these guidelines for me is the way the advised use of steroids has changed. They now say to start reducing the dose after two or three weeks and aim to be off them completely in six weeks. That sounds wonderful compared with what many of us went through.
Oh that was quick. They were talking about how it may take a long time for everyone to agree to it at the PDSA conference this summer. Guess their wasn't much disagreement.
Need to read through the whole thing. On skimming, I'm a little disappointed they didn't go into detail about why a TPO diagnostic test is, or is not, helpful. As I recall from the relevant study, TPO level predicts TPO-RA dosage - which aligns with my ITP treatments table. Maybe I missed it in the document.
Not sure NK. I don't respond to steroids so details about steroids seems to go in one ear and out the other quite easily. What I recall is a desire for treatment protocol being able to go from steroids directly to Promacta/Nplate. That does seem to be in there.
Had the opportunity to read the whole thing. A few things came to mind.
- Noting that
"vitamin B12 and Folate deficiency can result in thrombocytopenia"
is useful and enlightening
- No discussion on Promacta doses greater than 75mg (new for 2019?)
- This footnote referenced sentence:
"a prospective case-control study found no increased incidence of ITP following vaccination (evidence level IIb)"
contradicts the rest of the paragraph on "Testing for other acute and persistent infections"
- No mention that TPO level is a cursory predictor of TPO-RA dose. This information would allow skipping to higher Nplate doses when appropriate. Low TPO level indicates low TPO-RA dose. Normal level indicates medium dose. High level indicates high dose required.
- On IVIG studies:
"Two have found a reduced IVIg response in patients with only anti–GPIb-IX antibodies."
Well, that's a good start. How about studying those that achieve remission via TPO-RA treatment only? That they are the folks who have poor IVIG responses.
- This assertion on children, I think from what I've seen around here, is true for adults as well:
"Two studies have indicated that response to rituximab is correlated with steroid response (P = .002) (evidence level IIb)"
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