However, the Delphi method allowed exploring systematically the management of adult patients with ITP based on the qualified opinion of physicians routinely treating these patients

However, the Delphi method allowed exploring systematically the management of adult patients with ITP based on the qualified opinion of physicians routinely treating these patients. 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 Ledipasvir acetone platelet count 20 x 109/L; and considering mucosal or severe bleeding as a basic criterion for hospital admission. Conclusions The present Ledipasvir acetone consensus document provides a reference framework for the management of patients with ITP in clinical practice. 1. Introduction Immune thrombocytopenia (ITP) is an acquired autoimmune disorder defined by isolated thrombocytopenia in the absence of other conditions associated with thrombocytopenia. Given the variability of ITP in clinical presentation, symptoms, and clinical course, the diagnosis relies on the exclusion of an alternative etiology for thrombocytopenia [1C4]. Regarding the pathogenesis, thrombocytopenia seems to be the result of dysregulation of the immune response, including the presence of antiplatelet antibodies, platelet destruction mediated by T-cells and the reticuloendothelial system, and impaired megakaryocyte function. The involvement of these pathogenic mechanisms may vary in the individual patient [2, 5C7]. Recommendations on standardization of terminology, definitions, and criteria of response of ITP were published in 2009 2009 [8]. Different consensus documents for the diagnosis and treatment of ITP published subsequently [9C12] have been of remarkable value to reduce heterogeneity in the classification of patients and to improve the design and interpretation of results of clinical trials. Also, the reduced relevance of the platelet count in the occurrence of specific bleeding symptoms has contributed to improve the management of the disease by reducing adverse effects related to inadequate treatments [13, 14]. The development of drugs that can delay or even avoid the need of performing a splenectomy, such as thrombopoietin receptor agonists (TRAs), romiplostim, and eltrombopag [15C18], has been crucial to decrease morbidity, historically related to infections and bleeding. ITP is a heterogeneous disease whose evolution and response to treatment is unpredictable at diagnosis [19]. The availability of new therapeutic options has raised new questions in the current approach to ITP management, introducing considerable variability in clinical practice. A recent multicenter study carried out in 15 Spanish hospitals Ledipasvir acetone showed remarkable differences in diagnosis and treatment of patients with ITP [20]. Thus, unanswered questions remain, such as how to identify patients who need treatment since many are asymptomatic despite thrombocytopenia or, in case of need for treatment, how to select the most appropriate option. In most cases an individualized approach is required considering platelet count, presence of bleeding, lifestyle, and other patient characteristics as well as potential adverse effects of treatment. In order to clarify uncertainties about patient management and to select the most adequate treatment, a study using the Delphi method has been carried out on different aspects associated with the diagnosis of ITP, first- and second-line treatments, followup, and therapeutic approach in special settings. The objective of this project was to assess the level of agreement among expert hematologists regarding the best clinical practices for the diagnosis and management of patients with ITP. 2. Materials and Methods In order to establish the present recommendations on the management of ITP patients in daily clinical practice, a consultation was made to a group of hematologists experts in the care of patients with ITP, members of the Spanish ITP Group (GEPTI) of the Spanish Society of Hematology and Edg3 Hemotherapy (SEHH) routinely manage. Different aspects of the disease Ledipasvir acetone that in.