Primary immune thrombocytopenic purpura: approaches to therapy according to new clinical recommendations of the American hematology association and an International consensus report

Although there are numerous publications on the diagnosis and treatment of immune thrombocytopenia (ITP), knowledge gaps remain, and up-to-date expert opinion and experience are key. The article presents an updated version of the recommendations of the American Hematology society and the International consensus published in 2019. The panel for this update includes experts from around the world. Research results were analyzed and evaluated, and consensus recommendations based on new data were formulated. The panel agreed on recommendations covering management of ITP in patients with newly diagnosed, persistent, and chronic disease refractory to first-line therapy. Management approaches included: observation, corticosteroids, intravenous immunoglobulin, anti-D immunoglobulin, rituximab, splenectomy, and thrombopoietin receptor agonists. In general, strategies that avoided medication side effects were favored. A large focus was placed on shared decision-making. Experts pay great attention to second line of therapy. The guidelines place a priority on TPO-RAs as second-line treatment with rituximab being considered a third-line agent reserved for patients who have failed a TPO-RA. Additionally, splenectomy is not directly compared with either treatment but rather is primarily reserved for patients with ITP for 12 months’ durations or major bleeding (WHO III, IV). The article presents a detailed analysis of the recommendations and comments of the author.