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Unique Identifier 98215375
Authors: George JN. Woolf SH. Raskob GE.
Institution: Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City 73190, USA. Jim-George:OUHSC.edu
Title: Idiopathic thrombocytopenic purpura: a guideline for diagnosis and management of children and adults. American Society of Hematology.
Source: Annals of Medicine. 30(1)38-44, 1998 Feb.
Abstract: Idiopathic thrombocytopenic purpura (ITP, also known as immune thrombocytopenic purpura) affects both children and adults. In childhood, the peak age is 2-4 years, girls and boys are equally affected, and in most children, the disease is self-limited with spontaneous recovery occurring in several weeks to several months. In adults, ITP is most common among young women, and the disease is more insidious in its onset and chronic in its course. In both children and adults, there are important unresolved issues in diagnosis and management that have major cost implications. For this reason, the American Society of Hematology chose ITP as the disease topic for its initial practice guideline in 1993. In 1996, the practice guideline was published in Blood, the Journal of the American Society of Hematology. This review describes the principle features of ITP in children and adults, the process of development of the practice guideline for ITP, and the implications of the guideline for the diagnosis and management of patients with ITP.

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Unique Identifier 97182521
Authors: Anonymous.
Institution: National Institutes of Health, Bethesda, Maryland, USA.
Title: Diagnosis and treatment of idiopathic thrombocytopenic purpura: recommendations of the American Society of Hematology. The American Society of Hematology ITP Practice Guideline Panel
Source: Annals of Internal Medicine. 126(4)319-26, 1997 Feb 15. [see comments]
Abstract: To develop guidelines for the diagnosis and management of idiopathic thrombocytopenic purpura (ITP) and to document the extent to which those guidelines are based on either scientific evidence or opinion, the AMerican Society of Hematology established a panel composed of 13 hematologists with expertise in ITP, a clinical epidemiologist, and a practice guidelines methodologist. A comprehensive review was done of all published English-language studies that met explicit inclusion criteria and that evaluated the natural history of ITP or the effectiveness of testing and treatment options for ITP. The quality of each study was graded by two reviewers using formal methodologic rules. In subject areas for which data was inadequate, recommendations were based on opinion and were derived by using a formal screening procedure. Confidential questionnaires were used to survey the hematologists on the panel about the appropriateness of testing and treatment options in hundreds of clinical scenarios. Practice recommendations were derived from the mean appropriateness scores for each indication. Voting was kept confidential to give each panel member an equal voice and to limit biases introduced by group dynamics. The recommendations were peer reviewed by eight outside experts. This report focuses on data and on recommendations for adults with ITP. Little high-quality scientific evidence with which to assess the efficacy of diagnostic tests and treatments for ITP is available. The opinion of the panel was that most diagnostic tests are unnecessary in the routine work-ups of patients suspected of having ITP and that ITP accompanied by severe bleeding requires treatment with glucocorticoids, intravenous immunoglobin, and other measures. However, treatment and hospitalization is often unnecessary when patients have only mild or moderate thrombocytopenia or minimal bleeding. Special therapeutic measures are sometimes indicated in pregnant women with ITP.

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Unique Identifier 97121177
Authors: Anonymous.
Institution: Central Laboratory of the Red Cross Blood Transfusion Service, Department of Autoimmune Diseases, Amsterdam, The Netherlands.
Title: Diagnosis and treatment of idiopathic thrombocytopenic purpura. American Society of Hematology ITP Practice Guideline Panel. [Review] [30 refs]
Source: American Family Physician. 54(8)2437-47, 2451-2, 1996 Dec.
Abstract: The American Society of Hematology established a panel to develop practice guidelines for the diagnosis and management of idiopathic thrombocytopenic purpura and to document the extent to which the recommendations are based on either scientific evidence or opinion. A comprehensive literature review found little high-quality scientific evidence to define the natural history of idiopathic thrombocytopenic purpura or to assess the efficacy of diagnostic tests and treatments for the disorder. Recommendations were therefore based on opinion, derived from a formal scoring procedure. In the panel's opinion, in most cases only a history, physical examination and complete blood cell count with examination of the peripheral blood smear are necessary in the routine work-up of patients with suspected idiopathic thrombocytopenic purpura. The panel suggests different treatment approaches in children and adults because of important differences in the behavior of the disease in the two patient groups. The panel recommends that idiopathic thrombocytopenic purpura accompanied by severe bleeding be treated with glucocorticoids, intravenous immunoglobulin and other measures, but that treatment and hospitalization are often unnecessary when patients have only mild to moderate thrombocytopenia or minimal bleeding. Idiopathic thrombocytopenic purpura in pregnant women and the risk of thrombocytopenia in their newborns pose specific problems for diagnosis and treatment. [References: 30]

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