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ASH Releases New Clinical Practice Guidelines on Immune Thrombocytopenia

(Washington, DC, Dec. 3, 2019) — Today, ASH published new state-of-the art guidelines on the treatment of immune thrombocytopenia (ITP), a rare blood disorder characterized by a decrease in the number of platelets, the part of the blood needed for normal clotting. The guidelines are published in the journal Blood Advances.

The 2019 ASH Clinical Practice Guidelines on ITP, developed in partnership with the University of Oklahoma Health Sciences Center, synthesize all available evidence about existing treatments to offer recommendations for disease management in both children and adults. Notably, these new guidelines address appropriate corticosteroid use in adults and stress avoiding unnecessary treatment in children. They also tackle the complex decision-making surrounding second-line agents. They are intended to help hematologists educate other physicians who provide care to people with ITP and aid in shared patient-physician decision making. Where evidence gaps exist, the guidelines make recommendations for future research.

“Through these guidelines, ASH is helping to ensure that physicians and patients have access to all of the evidence available so they can evaluate various treatment options and make an informed decision, using the guideline recommendations as a foundation for care,” said Cindy Neunert, MD, chair of the ASH ITP guideline panel and a hematologist at New York-Presbyterian Hospital in New York City. “The guidelines also equip hematologists, the experts in ITP, to educate other providers who often see these patients first, such as emergency room physicians, pediatricians, or primary care physicians, who are often less familiar with this disease and its treatments.”

ITP affects about 2.5 in every 100,000 people in the United States, according to the Centers for Disease Control and Prevention. For most, ITP causes bruising and petechiae, small red dots on the skin. In more severe cases, it can cause more significant bleeding episodes, such as nose bleeds or bleeding in the moist lining of the mouth, gastrointestinal bleeding, or heavy and prolonged menstrual bleeding. Even without severe bleeding, ITP can still have a significant impact on patients’ quality of life in the form of fatigue, an inability to do the activities they enjoy, and side effects from treatments. 

ITP can be diagnosed at any age, but it is most likely to occur in early childhood and late adulthood. The natural course of the disease looks different in children than it does in adults. The 2019 ASH guidelines take these differences into account, continuing to fulfill a long-recognized need for specific guidance for each population from initial ITP guidelines ASH published in 2011.

In children, the reduction in platelets is often sudden, but platelet levels usually return to normal levels within weeks to months without treatment. The guidelines can help physicians avoid giving interventions and treatments that have little evidence of success and may have side effects that outweigh potential benefits. Development of ITP in adulthood is often more gradual and tends to persist. The guidelines offer new recommendations for use of corticosteroids, often a first-line treatment for adults, that will help physicians evaluate when they should be used, which corticosteroid should be given, the duration of use, and how usage should be monitored. Recommendations for second-line treatments are also provided.

“The 2019 ASH Clinical Practice Guidelines on ITP are a trustworthy resource for patient care in that they are the product of a rigorous process that met the highest standards of transparency,” said Dr. Neunert. “Our multidisciplinary guidelines panel included both adult and pediatric clinical experts, methodologists with expertise in ITP, and two patient representatives, whose perspectives were extremely valuable in helping us to evaluate the impact of various disease management options on quality of life.”

These ITP guidelines are an update from guidelines the Society published in 2011. They are the most recent product of a larger guideline development initiative for ASH, which includes a commitment to the timely update of existing guidelines and the development of new ones on a range of hematologic conditions. In the coming months, resources to aid in the implementation of the guidelines will be added to the ASH website.

For the guideline text as well as more information and resources to assist in understanding the 2019 ASH Clinical Practice Guidelines on ITP, visit www.hematology.org/ITPguidelines

The American Society of Hematology (ASH) (www.hematology.org) is the world’s largest professional society of hematologists dedicated to furthering the understanding, diagnosis, treatment, and prevention of disorders affecting the blood. For more than 60 years, the Society has led the development of hematology as a discipline by promoting research, patient care, education, training, and advocacy in hematology. ASH publishes Blood (www.bloodjournal.org), the most cited peer-reviewed publication in the field, and Blood Advances (www.bloodadvances.org), an online, peer-reviewed open-access journal.

Andrea Fischer, American Society of Hematology
[email protected]; 202-823-4884