Proposal of treatment algorithm for immune thromocytopenia in adult patients of a hematology service at a referral center in Northeastern Brazil

ABSTRACT

ABSTRACT Introduction: The management of adult (≥18 years) immune thrombocytopenia patients relies on platelet count, the risk of bleeding and presence of bleeding. Objective: Confirming the diagnosis of immune thrombocytopenia and the start of therapy, our hematology service, a referral center, favors the establishment of this algorithm to treat those patients. Results: Presentation, recently diagnosed or recurrence - group 1 life-threatening bleeding high-dose intravenous immunoglobulins with methylprednisolone or dexamethasone. Hospitalization and platelet transfusion are considered. Group 2 Platelets <30 × 109/L with bleeding or risk factor for bleeding, or platelets <20 × 109/L prednisone or dexamethasone. No response, platelets <20 × 109/L replace corticoid or increase doses. If platelets continue <20 × 109/L immunization and splenectomy. Investigation of Helicobacter pylori, if positive treatment for H. pylori. Chronic immune thrombocytopenia with platelets <20 × 109/L we propose two new groups (A and B) Group A <65 years, no or low surgical risk, patient declines maintenance therapy or patient intends to get pregnant immunization and splenectomy. Group B failure of splenectomy (refractory) or no splenectomy indication or history of exposure to malaria or babesiosis and no response to corticoids or corticoid dependence choose thrombopoietin receptor agonists eltrombopag or romiplostim. Patient at high risk for arterial or venous thrombosis recommend rituximab. After rituximab or thrombopoietin receptor agonists, if platelets continue <20 × 109/L indicate immunosuppressants (azathioprine or cyclophosphamide), dapsone or mycophenolate mofetil or vinca alkaloids. The goals of treatment for chronic or refractory immune thrombocytopenia are to keep platelets >20 × 109/L and stop bleeding.