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General Article on Treatment of ITP

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11 years 10 months ago #40472 by Rob16
General Article on Treatment of ITP was created by Rob16
Excellent up-to-date article on treatment of ITP.
This is updated and adapted from the ASH 2011 Evidence-based practice guideline for ITP, and written by the same author.
Equal emphasis on pediatric and adult.
Even mentions low-dose Rituxan.

Current management of immune thrombocytopenia
Cindy E. Neunert, Department of Pediatrics and Cancer Center, Georgia Regents University, Augusta, GA
asheducationbook.hematologylibrary.org/content/2013/1/276.full.pdf
doi: 10.1182/asheducation-2013.1.276 ASH Education Book December 6, 2013 vol. 2013 no. 1 276-282
The following user(s) said Thank You: midwest6708, reboot

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11 years 10 months ago #40483 by Winnifred
Replied by Winnifred on topic General Article on Treatment of ITP
Interesting article yet it is still saying spleen removal is 2nd line of treatment! I question that part

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11 years 10 months ago #40487 by Rob16
Replied by Rob16 on topic General Article on Treatment of ITP
At least she gives splenectomy, Rituxan, and TPOs equal standing, and admits some of the downsides to splenectomy. Better than most!

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  • karenr
  • Offline
  • Diagnosed in 2000, at 59, after being on moderately high doses of NSAIDs for arthritis. Splenectomy and rituxan both failed (2004). Did well on prednisone till summer 2018--then terrible reactions. Promacta since 11-19.
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11 years 10 months ago #40494 by karenr
Replied by karenr on topic General Article on Treatment of ITP
I note she also suggests 1-2 mg prednisone for every kg of weight. I'm grateful my hematologist never subscribed to such a high dose.

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11 years 10 months ago - 11 years 10 months ago #40508 by Rob16
Replied by Rob16 on topic General Article on Treatment of ITP
I agree this seems high, but it is a rescue dose, not a maintenance dose.
The PDSA page on corticosteroid use has a similar dosage:

The usual starting dose for prednisone or prednisolone for ITP patients is .5 to 2 mg/kg. for 2-4 weeks before tapering, depending on the response.
www.pdsa.org/treatments/conventional/corticosteroids.html

This is based on the International consensus report on the investigation and management of primary immune thrombocytopenia (2010):

Prednisone is the standard initial first-line therapy for ITP patients. Prednisone is usually given at 0.5 to 2 mg/kg/d until the platelet count increases (≥ 30-50 × 109/L), which may require several days to several weeks.
bloodjournal.hematologylibrary.org/content/115/2/168.full

For comparison, the high dose dexamethasone pulse 40 mg x 4 days is equivalent to 267 mg prednisone, which is 1 mg/kg for a 121 pound person - and only for 4 days.
Edit: Fixed arithmetic twice... that kind of day!

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IMPORTANT!

The Platelet Disorder Support Association does not provide medical advice or endorse any medication, vitamins or herbs. The information contained herein is not intended nor implied to be a substitute for professional medical advice and is provided for educational purposes only. Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment, discontinuing an existing treatment and to discuss any questions you may have regarding your unique medical condition.