Management of Primary Immune Thrombocytopenia: Turkish Modified Delphi-Based Consensus Statement for Special Considerations

Management of Primary Immune Thrombocytopenia: Turkish Modified Delphi-Based Consensus Statement for Special Considerations [Turk J Hematol]

Turk J Hematol. 2024; 41(3): 141-145 | DOI: 10.4274/tjh.galenos.2024.2024.0101

Management of Primary Immune Thrombocytopenia: Turkish Modified Delphi-Based Consensus Statement for Special Considerations

Elif �mit¹, Ahmet Muzaffer Demir¹, Muhlis Cem Ar², Mesut Ayer³, Meltem Ayl�⁴, Volkan Karaku�⁵, Emin Kaya⁶, Fahir �zkalemka�⁷, Nilg�n Say�nalp⁸, Mehmet S�nmez⁹, Fahri �ahin¹⁰, Selami Ko�ak Toprak¹¹, Tayfur Topta�¹², �rfan Yava�o�lu¹³, �mran �al��¹⁴
¹Trakya University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Edirne, T�rkiye
²�stanbul University-Cerrahpa�a, Cerrahpa�a Faculty of Medicine, Department of Internal Medicine, Division of Hematology, �stanbul, T�rkiye
³University of Health Sciences T�rkiye, Ba�ak�ehir �am and Sakura City Hospital, Clinic of Hematology, �stanbul, T�rkiye
⁴University of Health Sciences T�rkiye, G�lhane Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, T�rkiye
⁵University of Health Sciences T�rkiye, Antalya Training and Research Hospital, Clinic of Hematology, Antalya, T�rkiye
⁶�n�n� University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Malatya, T�rkiye
⁷Bursa Uluda� University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Bursa, T�rkiye
⁸Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, T�rkiye
⁹Karadeniz Technical University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Trabzon, T�rkiye
¹⁰Ege University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, �zmir, T�rkiye
¹¹Ankara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, T�rkiye
¹²Marmara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, �stanbul, T�rkiye
¹³Ayd�n Adnan Menderes University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ayd�n, T�rkiye
¹⁴Abdi �brahim �la� Sanayi ve Tic. A.�., Senior Medical Manager, �stanbul, T�rkiye

Objective: Primary immune thrombocytopenia (ITP) is an acquired disorder of platelets with a complex and unclear mechanism of increased immune destruction or impaired production of platelets. While the management of ITP is evolving, there is still a need for guidance, particularly in certain circumstances such as pregnancy, emergencies, or patients requiring co-medications. We aimed to determine the tendencies of hematologists in T�rkiye in the event of such special considerations.
Materials and Methods: Applying a modified Delphi method, the Turkish National ITP Working Group, founded under the auspices of the Turkish Society of Hematology, developed a questionnaire consisting of statements regarding pregnancy, emergencies, and circumstances requiring co-treatment with antiaggregants or anticoagulants. A total of 107 hematologists working in university or state hospitals voted for their agreement or disagreement with the statements for two sequential rounds.
Results: The participating hematologists reached an agreement on starting treatment for pregnant patients with platelets of less than 30x109/L and delivery either vaginally or by cesarean section being safe at platelet counts above 50x109/L. For emergencies and the rescue management of ITP, the panel agreed against the use of high-dose corticosteroids alone, preferring combinations with transfusions or intravenous immunoglobulin. For patients who require interventions, platelet counts of >50x109/L were regarded as safe for low-risk procedures as well as co-treatment with antiplatelets or anticoagulants.
Conclusion: As the National ITP Study Group, we have observed the need to increase the practice guidance regarding patients with primary ITP requiring additional treatments including invasive interventions and co-treatments for coagulation. Decisions on the management of ITP during pregnancy should be individualized. There is a lack of consensus on the thresholds of platelet counts as well as co-morbidities and co-medications. This lack of consensus may be due to variations in practices.

Keywords: Adult primary immune thrombocytopenia, Management, Delphi method, Special considerations

Primer �mm�n Trombositopeni Y�netimi: �zel Durumlar i�in D�zenlenmi� T�rkiye Delphi Temelli Konsensus Bildirisi

Ama�: Primer imm�n trombositopeni (ITP), trombositlerin karma��k ve tam ayd�nlanmam�� bir mekanizma ile artm�� imm�n y�k�m ya da azalm�� yap�m�na ba�l� olarak azald�� edinsel bir hastal�kt�r. ITP tedavisi geli�mek ile birlikte, gebelik, acil durumlar ve ek tedavi gereksinimi gibi �zel durumlar�n y�netimi i�in rehberlere ihtiya� vard�r. �al��mam�zdaki ama�, T�rkiye�deki hematologlar�n bu �zel durumlara yakla��m�n� belirlemektir.
Gere� ve Y�ntem: T�rk Hematoloji Derne�i alt�nda kurulan Ulusal ITP �al��ma Grubu taraf�ndan olu�turulan bir anket ile modifiye bir Delphi metodu kullan�larak, gebelik, acil ve ek tedavi gereksiniminde ITP�ye yakla��m hedeflenmi�tir. �niversite ve devlet hastanelerinde g�rev yapmakta olan 107 hematoloji uzman�na iki tur halinde bu sorular y�neltilmi�tir.
Bulgular: Kat�l�mc� hematologlar, gebelikte trombositin 30x109/L alt�na inmesi ile tedavi ba�lanmas� gerekti�i ve 50x109/L �zerindeki de�erlerde normal ya da sezaryen do�umun g�venli olaca�� konusunda g�r�� birli�ine varm��t�r. Acil ve kurtarma tedavilerine ili�kin olarak kat�l�mc�lar�n tek ba��na y�ksek doz kortikosteroidden ziyade transf�zyon ya da intraven�z imm�noglobulin ile kombine kullan�m�n� tercih ettikleri g�zlenmi�tir. D��k kanama riskli giri�imsel i�lemler ya da antiagregan veya antikoagulan gibi ek tedavi gereksiniminde 50x109/L �zerindeki trombosit de�erlerinin g�venli olabilece�i konusunda fikir birli�i g�zlenmi�tir.
Sonu�: Ulusal ITP �al��ma grubu olarak giri�imsel i�lemler ve p�ht�la�ma sistemine y�nelik ek tedavilerin gerekti�i �zel durumlarda ITP y�netimine ili�kin uygulama rehberlerine ihtiya� oldu�unu g�zlemledik. Gebelikte ITP�nin y�netimine ili�kin kararlar bireyselle�tirilmelidir. Trombosit say�s� e�ikleri, e�lik eden hastal�klar ve birlikte kullan�lan ila�lar konusunda bir fikir birli�i eksikli�i vard�r. Bu fikir birli�i eksikli�i klinik pratikteki farkl�l�klardan kaynaklan�yor olabilir.

Anahtar Kelimeler: Eri�kin primer imm�n trombositopeni, Hastal�k y�netimi, Delphi metodu, �zel durumlar

Elif �mit, Ahmet Muzaffer Demir, Muhlis Cem Ar, Mesut Ayer, Meltem Ayl�, Volkan Karaku�, Emin Kaya, Fahir �zkalemka�, Nilg�n Say�nalp, Mehmet S�nmez, Fahri �ahin, Selami Ko�ak Toprak, Tayfur Topta�, �rfan Yava�o�lu, �mran �al��. Management of Primary Immune Thrombocytopenia: Turkish Modified Delphi-Based Consensus Statement for Special Considerations. Turk J Hematol. 2024; 41(3): 141-145

Corresponding Author: Elif �mit

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