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Blood Res 2017; 52(4):
Published online December 31, 2017
https://doi.org/10.5045/br.2017.52.4.254
© The Korean Society of Hematology
Management of immune thrombocytopenia: Korean experts recommendation in 2017
1Department of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
2Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea.
3Department of Internal Medicine, Ewha Womans' University School of Medicine, Seoul, Korea.
4Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
5Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, Korea.
6Department of Internal Medicine, Seoul National University Hospital, Korea.
7Department of Pediatrics, Chung-Ang University Hospital, Seoul, Korea.
8Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.
9Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
10Department of Pediatrics, Chonnam National University Hwasun Hospital, Hwasun, Korea.
Correspondence to : Jong Wook Lee, M.D. Division of Hematology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea. jwlee@catholic.ac.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Management options for patients with immune thrombocytopenia (ITP) have evolved substantially over the past decades. The American Society of Hematology published a treatment guideline for clinicians referring to the management of ITP in 2011. This evidence-based practice guideline for ITP enables the appropriate treatment of a larger proportion of patients and the maintenance of normal platelet counts. Korean authority operates a unified mandatory national health insurance system. Even though we have a uniform standard guideline enforced by insurance reimbursement, there are several unsolved issues in real practice in ITP treatment. To optimize the management of Korean ITP patients, the Korean Society of Hematology Aplastic Anemia Working Party (KSHAAWP) reviewed the consensus and the Korean data on the clinical practices of ITP therapy. Here, we report a Korean expert recommendation guide for the management of ITP.
Keywords Aplastic Anemia Working Party, ITP, Recommendation, Management
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Review Article
Blood Res 2017; 52(4): 254-263
Published online December 31, 2017 https://doi.org/10.5045/br.2017.52.4.254
Copyright © The Korean Society of Hematology.
Management of immune thrombocytopenia: Korean experts recommendation in 2017
Jun Ho Jang1,#, Ji Yoon Kim2,#, Yeung-Chul Mun3, Soo-Mee Bang4, Yeon Jung Lim5, Dong-Yeop Shin6, Young Bae Choi7, Ho-Young Yhim8, Jong Wook Lee9*, Hoon Kook10*, and on the behalf of Korean Aplastic Anemia Working Party
1Department of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
2Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea.
3Department of Internal Medicine, Ewha Womans' University School of Medicine, Seoul, Korea.
4Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
5Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, Korea.
6Department of Internal Medicine, Seoul National University Hospital, Korea.
7Department of Pediatrics, Chung-Ang University Hospital, Seoul, Korea.
8Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.
9Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
10Department of Pediatrics, Chonnam National University Hwasun Hospital, Hwasun, Korea.
Correspondence to:Jong Wook Lee, M.D. Division of Hematology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea. jwlee@catholic.ac.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Management options for patients with immune thrombocytopenia (ITP) have evolved substantially over the past decades. The American Society of Hematology published a treatment guideline for clinicians referring to the management of ITP in 2011. This evidence-based practice guideline for ITP enables the appropriate treatment of a larger proportion of patients and the maintenance of normal platelet counts. Korean authority operates a unified mandatory national health insurance system. Even though we have a uniform standard guideline enforced by insurance reimbursement, there are several unsolved issues in real practice in ITP treatment. To optimize the management of Korean ITP patients, the Korean Society of Hematology Aplastic Anemia Working Party (KSHAAWP) reviewed the consensus and the Korean data on the clinical practices of ITP therapy. Here, we report a Korean expert recommendation guide for the management of ITP.
Keywords: Aplastic Anemia Working Party, ITP, Recommendation, Management
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Recommended work-up for the diagnosis of ITP in adult patients. a)Include rapid urease test, urea breath test, or stool
H. pylori antigen assay. b)In selected cases with patients ≥60 years old, no appropriate response to therapy, or plan for splenectomy..Abbreviations: HBV, hepatitis B virus; HCV, hepatitis C virus; HIV, human immunodeficiency virus;
H. pylori ,Helicobacter pylori ; Rh, rhesus..
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Causes of secondary ITP in children. Adapted from Neunert et al. [3].
Abbreviations: CMV, cytomegalovirus; IgA, immunoglobulin A; VZA, varicella zoster virus..
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Diagnostic elements of ITP in children. Adapted from George et al. [39] and Provan et al. [8]..
a)Test in selected cases..
Abbreviations: CNS, central nervous system; DTaP, a vaccine for diphtheria, pertussis, and tetanus; GI, gastrointestine; GU, genitourinary; MMR, measles-mumps-rubella combined vaccine; PCR, polymerase chain reaction..
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Definition of medically unfit condition to splenectomy recommended by the Korean ITP Expert Group. a)Platelet counts less than 30×109/L or not increasing to double from the baseline..
Abbreviations: BMI, body mass index; COPD, chronic obstructive pulmonary disease; DM, diabetes mellitus..
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