Immune Thrombocytopenia medical therapy: Difference between revisions

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*[[Vinca alkaloids]] <ref name="KohliChaturvedi2019">{{cite journal|last1=Kohli|first1=Rahil|last2=Chaturvedi|first2=Shruti|title=Epidemiology and Clinical Manifestations of Immune Thrombocytopenia|journal=Hämostaseologie|volume=39|issue=03|year=2019|pages=238–249|issn=0720-9355|doi=10.1055/s-0039-1683416}}</ref>
*[[Vinca alkaloids]] <ref name="KohliChaturvedi2019">{{cite journal|last1=Kohli|first1=Rahil|last2=Chaturvedi|first2=Shruti|title=Epidemiology and Clinical Manifestations of Immune Thrombocytopenia|journal=Hämostaseologie|volume=39|issue=03|year=2019|pages=238–249|issn=0720-9355|doi=10.1055/s-0039-1683416}}</ref>


Emergency therapy for ITP recommended for patients with platelet counts less than 10<math>\times10^{9}</math>/L with severe life threatening bleeding in [[Gastrointestinal tract|gastrointestinal]] , [[Genitourinary system|genitourinary]] tract and [[central nervous system]].<ref name="pmiddoi.org/10.1007/s12185-018-2445-z">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=doi.org/10.1007/s12185-018-2445-z | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }}</ref>
Emergency therapy for ITP recommended for patients with platelet counts less than 10<math>\times10^{9}</math>/L with severe life threatening bleeding in [[Gastrointestinal tract|gastrointestinal]] , [[Genitourinary system|genitourinary]] tract and [[central nervous system]].


OR
OR
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****corticosteroids(2): [[prednisone]] 1 mg/kg/day PO for 2-4 weeks.Then taper to minimum maintenance dose of < 15mg/day.
****corticosteroids(2): [[prednisone]] 1 mg/kg/day PO for 2-4 weeks.Then taper to minimum maintenance dose of < 15mg/day.
****IVIG : [[Intravenous immunoglobulin|IVIG]] 400 mg/kg/day IV  for 5 days. '''(use with caution in patients with IgA deficiency or renal insufficiency''')
****IVIG : [[Intravenous immunoglobulin|IVIG]] 400 mg/kg/day IV  for 5 days. '''(use with caution in patients with IgA deficiency or renal insufficiency''')
****IVIG (1): [[drug name|IVIG]] 1000 mg/kg IV q6h single dose.<ref name="pmiddoi.org/10.1007/s12185-018-2445-z2">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=doi.org/10.1007/s12185-018-2445-z | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }}</ref>
****IVIG (1): [[drug name|IVIG]] 1000 mg/kg IV q6h single dose.<ref name="LiuBai2018">{{cite journal|last1=Liu|first1=Xin-guang|last2=Bai|first2=Xiao-chuan|last3=Chen|first3=Fang-ping|last4=Cheng|first4=Yun-feng|last5=Dai|first5=Ke-sheng|last6=Fang|first6=Mei-yun|last7=Feng|first7=Jian-Ming|last8=Gong|first8=Yu-ping|last9=Guo|first9=Tao|last10=Guo|first10=Xin-hong|last11=Han|first11=Yue|last12=Hong|first12=Luo-jia|last13=Hu|first13=Yu|last14=Hua|first14=Bao-lai|last15=Huang|first15=Rui-bing|last16=Li|first16=Yan|last17=Peng|first17=Jun|last18=Shu|first18=Mi-mi|last19=Sun|first19=Jing|last20=Sun|first20=Pei-yan|last21=Sun|first21=Yu-qian|last22=Wang|first22=Chun-sen|last23=Wang|first23=Shu-jie|last24=Wang|first24=Xiao-min|last25=Wu|first25=Cong-ming|last26=Wu|first26=Wen-man|last27=Yan|first27=Zhen-yu|last28=Yang|first28=Feng-e|last29=Yang|first29=Lin-hua|last30=Yang|first30=Ren-Chi|last31=Yang|first31=Tong-hua|last32=Ye|first32=Xu|last33=Zhang|first33=Guang-sen|last34=Zhang|first34=Lei|last35=Zheng|first35=Chang-cheng|last36=Zhou|first36=Hu|last37=Zhou|first37=Min|last38=Zhou|first38=Rong-fu|last39=Zhou|first39=Ze-ping|last40=Zhu|first40=Hong-li|last41=Zhu|first41=Tie-nan|last42=Hou|first42=Ming|title=Chinese guidelines for treatment of adult primary immune thrombocytopenia|journal=International Journal of Hematology|volume=107|issue=6|year=2018|pages=615–623|issn=0925-5710|doi=10.1007/s12185-018-2445-z}}</ref>
****Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
****Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
****Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
****Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days

Latest revision as of 16:33, 1 February 2021

Immune Thrombocytopenia Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maryam Barkhordarian, M.D.[2]

Overview

There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR   The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is not recommended among patients with platelet count above 30<math>\times</math> <math>10^{9}</math>/L unless they are undergoing procedure or activities induce bleeding.

OR

First line pharmacologic medical therapies for immune thrombocytopenia include corticosteroid, anti- D antibody, and IVIG.

Corticosteroid treatment used in ITP include:

Second line medical therapy includes:

Emergency therapy for ITP recommended for patients with platelet counts less than 10<math>\times10^{9}</math>/L with severe life threatening bleeding in gastrointestinal , genitourinary tract and central nervous system.

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Medical Therapy

  • Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
  • Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
  • Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
  • Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Disease Name

  • First line - Name of stage
    • 1.1 Specific Organ system involved 1
      • 1.1.1 Adult
        • corticosteroids (1) Dexamethazone 40 mg QD for 4 days (use with caution patients with high copies of Hepatitis B virus DNA)
        • or
        • corticosteroids(2): prednisone 1 mg/kg/day PO for 2-4 weeks.Then taper to minimum maintenance dose of < 15mg/day.
        • IVIG : IVIG 400 mg/kg/day IV for 5 days. (use with caution in patients with IgA deficiency or renal insufficiency)
        • IVIG (1): IVIG 1000 mg/kg IV q6h single dose.[2]
        • Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
        • Alternative regimen (3): drug name 500 mg PO q6h for 14–21 days
      • 1.1.2 Pediatric
        • 1.1.2.1 (Specific population e.g. children < 8 years of age)
          • Preferred regimen (1): drug name 50 mg/kg PO per day q8h (maximum, 500 mg per dose)
          • Preferred regimen (2): drug name 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
          • Alternative regimen (1): drug name10 mg/kg PO q6h (maximum, 500 mg per day)
          • Alternative regimen (2): drug name 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
          • Alternative regimen (3): drug name 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
        • 1.1.2.2 (Specific population e.g. 'children < 8 years of age')
          • Preferred regimen (1): drug name 4 mg/kg/day PO q12h(maximum, 100 mg per dose)
          • Alternative regimen (1): drug name 10 mg/kg PO q6h (maximum, 500 mg per day)
          • Alternative regimen (2): drug name 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
          • Alternative regimen (3): drug name 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
    • 1.2 Specific Organ system involved 2
      • 1.2.1 Adult
        • Preferred regimen (1): drug name 500 mg PO q8h
      • 1.2.2 Pediatric
        • Preferred regimen (1): drug name 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
  • 2 Stage 2 - Name of stage
    • 2.1 Specific Organ system involved 1
      Note (1):
      Note (2):
      Note (3):
      • 2.1.1 Adult
        • Parenteral regimen
          • Preferred regimen (1): drug name 2 g IV q24h for 14 (14–21) days
          • Alternative regimen (1): drug name 2 g IV q8h for 14 (14–21) days
          • Alternative regimen (2): drug name 18–24 MU/day IV q4h for 14 (14–21) days
        • Oral regimen
          • Preferred regimen (1): drug name 500 mg PO q8h for 14 (14–21) days
          • Preferred regimen (2): drug name 100 mg PO q12h for 14 (14–21) days
          • Preferred regimen (3): drug name 500 mg PO q12h for 14 (14–21) days
          • Alternative regimen (1): drug name 500 mg PO q6h for 7–10 days
          • Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
          • Alternative regimen (3):drug name 500 mg PO q6h for 14–21 days
      • 2.1.2 Pediatric
        • Parenteral regimen
          • Preferred regimen (1): drug name 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
          • Alternative regimen (1): drug name 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
          • Alternative regimen (2):  drug name 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '(Contraindications/specific instructions)'
        • Oral regimen
          • Preferred regimen (1): drug name 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
          • Preferred regimen (2): drug name (for children aged ≥ 8 years) 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
          • Preferred regimen (3): drug name 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)
          • Alternative regimen (1): drug name 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)
          • Alternative regimen (2): drug name 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)
          • Alternative regimen (3): drug name 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)
    • 2.2 'Other Organ system involved 2'
      Note (1):
      Note (2):
      Note (3):
      • 2.2.1 Adult
        • Parenteral regimen
          • Preferred regimen (1): drug name 2 g IV q24h for 14 (14–21) days
          • Alternative regimen (1): drug name 2 g IV q8h for 14 (14–21) days
          • Alternative regimen (2): drug name 18–24 MU/day IV q4h for 14 (14–21) days
        • Oral regimen
          • Preferred regimen (1): drug name 500 mg PO q8h for 14 (14–21) days
          • Preferred regimen (2): drug name 100 mg PO q12h for 14 (14–21) days
          • Preferred regimen (3): drug name 500 mg PO q12h for 14 (14–21) days
          • Alternative regimen (1): drug name 500 mg PO q6h for 7–10 days
          • Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
          • Alternative regimen (3):drug name 500 mg PO q6h for 14–21 days
      • 2.2.2 Pediatric
        • Parenteral regimen
          • Preferred regimen (1): drug name 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
          • Alternative regimen (1): drug name 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
          • Alternative regimen (2):  drug name 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
        • Oral regimen
          • Preferred regimen (1): drug name 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
          • Preferred regimen (2): drug name 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
          • Preferred regimen (3): drug name 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)
          • Alternative regimen (1): drug name 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)
          • Alternative regimen (2): drug name 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)
          • Alternative regimen (3): drug name 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)

References

  1. Kohli, Rahil; Chaturvedi, Shruti (2019). "Epidemiology and Clinical Manifestations of Immune Thrombocytopenia". Hämostaseologie. 39 (03): 238–249. doi:10.1055/s-0039-1683416. ISSN 0720-9355.
  2. Liu, Xin-guang; Bai, Xiao-chuan; Chen, Fang-ping; Cheng, Yun-feng; Dai, Ke-sheng; Fang, Mei-yun; Feng, Jian-Ming; Gong, Yu-ping; Guo, Tao; Guo, Xin-hong; Han, Yue; Hong, Luo-jia; Hu, Yu; Hua, Bao-lai; Huang, Rui-bing; Li, Yan; Peng, Jun; Shu, Mi-mi; Sun, Jing; Sun, Pei-yan; Sun, Yu-qian; Wang, Chun-sen; Wang, Shu-jie; Wang, Xiao-min; Wu, Cong-ming; Wu, Wen-man; Yan, Zhen-yu; Yang, Feng-e; Yang, Lin-hua; Yang, Ren-Chi; Yang, Tong-hua; Ye, Xu; Zhang, Guang-sen; Zhang, Lei; Zheng, Chang-cheng; Zhou, Hu; Zhou, Min; Zhou, Rong-fu; Zhou, Ze-ping; Zhu, Hong-li; Zhu, Tie-nan; Hou, Ming (2018). "Chinese guidelines for treatment of adult primary immune thrombocytopenia". International Journal of Hematology. 107 (6): 615–623. doi:10.1007/s12185-018-2445-z. ISSN 0925-5710.

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