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Annals of Hematology

, Volume 95, Issue 7, pp 1089–1098 | Cite as

Real-life management of primary immune thrombocytopenia (ITP) in adult patients and adherence to practice guidelines

  • María Luisa LozanoEmail author
  • N. Revilla
  • T. J. Gonzalez-Lopez
  • S. Novelli
  • J. R. González-Porras
  • B. Sánchez-Gonzalez
  • N. Bermejo
  • S. Pérez
  • F. J. Lucas
  • M. T. Álvarez
  • M. J. Arilla
  • M. Perera
  • J. do Nascimento
  • R. M. Campos
  • L. F. Casado
  • V. Vicente
Original Article

Abstract

Very few data exist on the management of adult patients diagnosed with primary immune thrombocytopenia (ITP). The objectives of this study were to describe the diagnostic and treatment patterns for ITP and to compare the findings to recent ITP guidelines. We retrospectively analyzed the medical records of adult ITP patients diagnosed with primary ITP between January 2011 and June 2012 and examined whether management strategies were consistent or not with eight recent guideline-recommended practices. Overall, median age at the diagnosis of the disease (n = 101) was 58 years and median platelet count 12 × 109/L with 75.2 % of patients having symptoms of ITP. The study perceived two major shortcomings in the diagnostic approach: (1) failure to perform peripheral blood film examination in 22.8 % of patients, a test that is mandatory by all guidelines, and (2) ordinary bone marrow assessment in more than half of the patients at diagnosis (50.5 %), a test not routinely recommended by guidelines. Low appropriateness in therapeutic management of patients included (1) unjustified use of intravenous immunoglobulin in the absence of bleeding in 54.8 % of patients and (2) splenectomy not being deferred until 6–12 months from diagnosis (median 161 days). Data also reflect a trend towards the early use of thrombopoietin receptor agonists in the treatment of patients who are refractory to any first-line therapy. We have recognized important areas of inapropriateness in the diagnostic and therapeutic management of adult ITP patients. Compliance with established guidelines should be encouraged in order to improve patient outcomes.

Keywords

Primary immune thrombocytopenia ITP Guidelines Thrombopoietin receptor agonists Splenectomy Real-life practice 

Notes

Acknowledgments

This work was supported by Amgen S.A. Spain. Amgen did not have any role in study design, collection, analysis, and interpretation of data, writing the report, or in the decision to submit the report for publication. The authors thank Juan Luis Sanz (APICES, Madrid, Spain) for his contribution in the data management and statistical analysis of this study and for critically reviewing the manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • María Luisa Lozano
    • 1
    Email author
  • N. Revilla
    • 1
    • 2
  • T. J. Gonzalez-Lopez
    • 3
  • S. Novelli
    • 4
  • J. R. González-Porras
    • 5
  • B. Sánchez-Gonzalez
    • 6
  • N. Bermejo
    • 7
  • S. Pérez
    • 8
  • F. J. Lucas
    • 9
  • M. T. Álvarez
    • 10
  • M. J. Arilla
    • 11
  • M. Perera
    • 12
  • J. do Nascimento
    • 13
  • R. M. Campos
    • 14
  • L. F. Casado
    • 15
  • V. Vicente
    • 1
  1. 1.Hospital Morales MeseguerIMIB-ArrixacaMurciaSpain
  2. 2.Hospital Ramón y CajalMadridSpain
  3. 3.Hospital General de BurgosBurgosSpain
  4. 4.Hospital de la Santa Creu i Sant PauBarcelonaSpain
  5. 5.Hospital de SalamancaSalamancaSpain
  6. 6.Hospital del MarBarcelonaSpain
  7. 7.Hospital de San Pedro de AlcántaraCáceresSpain
  8. 8.Complejo Hospitalario Universitario de SantiagoSantiagoSpain
  9. 9.Hospital General de AlicanteAlicanteSpain
  10. 10.Hospital Universitario La PazMadridSpain
  11. 11.Hospital de SaguntoValenciaSpain
  12. 12.Hospital Gran Canaria Dr. NegrínGran CanariaSpain
  13. 13.Hospital General de Tarragona Joan XXIIITarragonaSpain
  14. 14.Hospital de JerezJerezSpain
  15. 15.Hospital Virgen de la SaludToledoSpain

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