A Retrospective Analysis of the Treatment Approach to Immune Thrombocytopenia in the Real World

Abstract

Introduction Immune thrombocytopenia (ITP) is an acquired cause of thrombocytopenia in both the adult and children populations due to the accelerated destruction of platelets and/or suppressed platelet production. We present a retrospective analysis of a case series of patients in a single teaching institution with the objective of describing the clinical characteristics and different treatment approaches of patients with ITP. Methods A review of electronic health records was performed in the University Hospital Samaritana, Bogota, for inpatients between 2013 and 2016. Data were extracted for the patients with an ITP diagnosis for variables previously chosen and reviewed for descriptive analysis. Results A total of 55 patients were diagnosed with ITP; of these, 67.3% were female and the median age of this group of patients was 48 years. The majority presented with severe thrombocytopenia with 80% of patients having platelets less than 30000/µL. Of the 55 patients with a final diagnosis of ITP, only 54 received dexamethasone, methylprednisolone, or prednisone as the first-line treatment. The increment in platelet count after seven days of treatment was greater in the group treated with dexamethasone. Conclusion The diagnosis of ITP is of exclusion, there is no gold standard test, however, as it was shown in our results, various unnecessary studies are performed that increase costs during the diagnostic approach. Evidence supports that treatment with high-dose dexamethasone is associated with faster short-and greater long-term efficacy as compared to other steroids, however, it is not always the first choice in real-world patients. It is our belief that the implementation of a guideline will reduce testing and costs, and ensure better treatment options for our patient population.

Efficacy and quality of life of Romiplostim in adults and children with immune thrombocytopenia: A review

“…In addition, immunosuppressants such as cyclosporine and cyclophosphamide, CD20 monoclonal antibodies and thrombopoietin receptor agonists have become new drugs in clinical treatment of ITP in recent years. [ 17 ] TPO is an important growth factor that regulates the proliferation and differentiation of megakaryocytes and mediates the production of platelets by megakaryocytes. As the second generation of TPO receptor agonists, Eltrombopag and Romiplostim are more reliable in treatment effect and safety compared with the first generation.…”