Immune thrombocytopenic purpura in adults.
OBJECTIVE
A review of recent studies was conducted to determine if guidelines promulgated by the American Society of Hematology and the British Committee for Standards in Haematology need to be updated as these were based mainly on expert opinion rather than outcomes derived from clinical trials.


RESULTS
Recent studies suggest that most patients with immune thrombocytopenic purpura have a disease that is generally well tolerated, with little morbidity. Splenectomy remains the best 'curative' treatment for adults with chronic disease (at least 6 months of follow up). Other treatments such as anti-D, rituximab or dexamethasone may allow the decision of splenectomy to be postponed, possibly indefinitely, if hemostatic platelet count is attained. Mortality from bleeding may be relevant only in patients refractory to splenectomy. Cytotoxic agents should be reserved for patients with bleeding refractory to other treatments.


CONCLUSIONS
Patients with platelet counts less than 30 x 10(9)/l or bleeding have to be treated but management decisions should also be based on lifestyle, age, and other medical conditions that may contribute to the risk of serious bleeding. An aggressive therapeutic approach is justified only in patients with platelet counts below 20 x 10(9)/l and those refractory to splenectomy. Newer therapies may be more targeted in their action.
Godeau
Bertrand
B
Department of Internal Medicine, Centre Hospitalier Universitaire, Hôpital Henri Mondor, Créteil, France. bertrand.godeau@hmn.aphp.fr
Provan
Drew
D
Bussel
James
J
D000328:Adult; D000367:Age Factors; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D002986:Clinical Trials as Topic; D003907:Dexamethasone / Q000627:therapeutic use*; D006405:Hematology; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy; D006801:Humans; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D018029:Rho(D) Immune Globulin / Q000627:therapeutic use*; D012307:Risk Factors; D000069283:Rituximab; D012955:Societies, Medical; D013156:Splenectomy / Q000009:adverse effects; D016896:Treatment Outcome; D006113:United Kingdom; D014481:United States
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018029:Rho(D) Immune Globulin; D000069283:Rituximab; D003907:Dexamethasone