American Society of Hematology Guidelines for the Management of Newly Diagnosed ITP in Adults and Children (adapted from the American Society of Hematology Guidelines for Immune Thrombocytopenia5 )
| Children |
| We recommend: |
| • Children with no bleeding or mild bleeding (defined as skin manifestations only, such as bruising and petechiae) be managed with observation alone regardless of platelet count (grade 1B); |
| • In pediatric patients requiring treatment, a single dose of IVIg (0.8-1.0) or a short course of steroids be used as first-line treatment (grade 1B); |
| • IVIg can be used if a more rapid increase in the platelet count is required (grade 1B); |
| • Anti-D immunoglobulin therapy is not advised in children with a hemoglobin concentration that is decreased due to bleeding or with evidence of autoimmune hemolysis (grade 1C). |
| We suggest: |
| • A single dose of anti-D immunoglobulin can be used as first-line treatment in Rh-positive, nonsplectomized children requiring treatment (grade 2B). |
| Adults |
| We suggest: |
| • Treatment be administered to for newly diagnosed patients with a platelet count <30 × 109/l (grade 2C); |
| • Longer courses of steroids are preferred over shorter courses of corticosteroids or IVIg as first-line treatment (grade 2B); |
| • IVIg can be used with corticosteroids when a more rapid increase in the platelet count is required (grade 2B); |
| • Either IVIg or anti-D immunoglobulin (in appropriate patients) be used as first-line treatment if corticosteroids are contraindicated (grade 2C); |
| • If IVIg is used, the dose should be initially 1 gm/kg as a 1-time dose; this dosage may be repeated if necessary (grade 2B). |
| Children |
| We recommend: |
| • Children with no bleeding or mild bleeding (defined as skin manifestations only, such as bruising and petechiae) be managed with observation alone regardless of platelet count (grade 1B); |
| • In pediatric patients requiring treatment, a single dose of IVIg (0.8-1.0) or a short course of steroids be used as first-line treatment (grade 1B); |
| • IVIg can be used if a more rapid increase in the platelet count is required (grade 1B); |
| • Anti-D immunoglobulin therapy is not advised in children with a hemoglobin concentration that is decreased due to bleeding or with evidence of autoimmune hemolysis (grade 1C). |
| We suggest: |
| • A single dose of anti-D immunoglobulin can be used as first-line treatment in Rh-positive, nonsplectomized children requiring treatment (grade 2B). |
| Adults |
| We suggest: |
| • Treatment be administered to for newly diagnosed patients with a platelet count <30 × 109/l (grade 2C); |
| • Longer courses of steroids are preferred over shorter courses of corticosteroids or IVIg as first-line treatment (grade 2B); |
| • IVIg can be used with corticosteroids when a more rapid increase in the platelet count is required (grade 2B); |
| • Either IVIg or anti-D immunoglobulin (in appropriate patients) be used as first-line treatment if corticosteroids are contraindicated (grade 2C); |
| • If IVIg is used, the dose should be initially 1 gm/kg as a 1-time dose; this dosage may be repeated if necessary (grade 2B). |