Immune Thrombocytopenia medical therapy: Difference between revisions
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Pharmacologic medical therapy is recommended among patients with | 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 | OR | ||
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Corticosteroid treatment used in ITP include: | Corticosteroid treatment used in ITP include: | ||
* [[Dexamethazone]] | *[[Dexamethazone]] | ||
* [[methylprednosoline]] | *[[methylprednosoline]] | ||
* [[Prednisone]] | *[[Prednisone]] | ||
Second line therapy includes: | Second line medical therapy includes: | ||
* [[Azathioprine]] | *[[Azathioprine]] | ||
* [[Ciclosporin|Cyclosporin A]] | *[[Ciclosporin|Cyclosporin A]] | ||
* [[Cyclophosphomide]] | *[[Cyclophosphomide]] | ||
* [[Danazol]] | *[[Danazol]] | ||
* [[Dapsone]] | *[[Dapsone]] | ||
* [[Mycofenolate mofetil]] | *[[Mycofenolate mofetil]] | ||
* [[Rituximab]] | *[[Rituximab]] | ||
* [[Splenectomy]] | *[[Splenectomy]] | ||
* TPO receptor agonists | *TPO receptor agonists | ||
* [[Vinca alkaloids]] | *[[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> | |||
OR | OR | ||
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===Disease Name=== | ===Disease Name=== | ||
*''' | *'''First line - Name of stage''' | ||
**1.1 '''Specific Organ system involved 1''' | **1.1 '''Specific Organ system involved 1''' | ||
***1.1.1 '''Adult''' | ***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 : [[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> | |||
****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 |
Revision as of 16:13, 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:
- Azathioprine
- Cyclosporin A
- Cyclophosphomide
- Danazol
- Dapsone
- Mycofenolate mofetil
- Rituximab
- Splenectomy
- TPO receptor agonists
- Vinca alkaloids [1]
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.[2]
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.[3]
- 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)
- 1.1.2.1 (Specific population e.g. children < 8 years of age)
- 1.1.1 Adult
- 1.2 Specific Organ system involved 2
- 1.1 Specific Organ system involved 1
- 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
- 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)
- Parenteral regimen
- 2.2 'Other Organ system involved 2'
- Note (1):
- Note (2):
- Note (3):
- 2.2.1 Adult
- Parenteral regimen
- 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)
- Parenteral regimen
- 2.1 Specific Organ system involved 1
References
- ↑ 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.
- ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes" Check
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value (help). Biochem Pharmacol. 24 (17): 1639–41. PMID doi.org/10.1007/s12185-018-2445-z Check|pmid=
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|url=
value (help). Biochem Pharmacol. 24 (17): 1639–41. PMID doi.org/10.1007/s12185-018-2445-z Check|pmid=
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