Recommendations for the diagnosis of ITP in adults and children according to ASH guidelines

ITP in Adults

a) Newly Diagnosed ITP

1. Testing for HCV and HIV is recommended.
2. It is suggested to search for other abnormalities in the blood count and blood smear, but bone marrow examination is not necessary in patients with typical ITP, regardless of age.

b) First-Line Treatment

1. Intravenous immunoglobulin (IVIG) can be combined with corticosteroids if a rapid increase in platelet count is needed.
2. If corticosteroids are contraindicated, IVIG is indicated as first-line treatment.
3. In the case of IVIG administration, the initial dose should be 1 g/kg at one time; the dose can be repeated if necessary.

c) Laparoscopic or Open Splenectomy

1. Both methods are suitable for indicated patients—they offer the same chance of achieving the desired effect.

d) Treatment of ITP in Pregnancy

1. If treatment is needed, either corticosteroids or IVIG is recommended.
2. The mode of delivery in pregnant women with ITP should be based on gynecological indications.

e) Treatment of Specific Forms of ITP—Associated with HCV

1. For patients with secondary ITP due to HCV infection, antiviral treatment should be primarily considered (in the absence of contraindications). However, platelet count should be closely monitored, as interferon treatment can worsen thrombocytopenia.
2. If ITP treatment is needed, IVIG should be administered.

f) Treatment of Specific Forms of ITP—Associated with HIV

1. In patients with ITP secondary to HIV infection, antiviral treatment should be considered primarily if the patient does not have significant clinical bleeding complications.
2. If ITP treatment is needed, the initial modality should be corticosteroids or IVIG; splenectomy is preferred in symptomatic patients who fail corticosteroid or IVIG therapy.

g) Treatment of Specific Forms of ITP—Associated with H. pylori Infection

1. If H. pylori infection is found, eradication with established treatment is indicated.
2. Screening for the presence of H. pylori should be considered in ITP patients who would be treated with eradication therapy upon a positive test result.

ITP in Children

a) Newly Diagnosed ITP

1. Recommendation: Bone marrow examination is not necessary in children and adolescents with a typical picture of ITP.
2. Recommendation: Bone marrow examination is not necessary in children in whom IVIG treatment has failed.
3. Suggestion: Bone marrow examination is also not necessary before starting corticosteroid treatment or before splenectomy.
4. Suggestion: Testing for antinuclear antibodies is not necessary in children and adolescents with probable ITP.

b) Children Who Do Not Respond to Treatment

1. Recommendation: Testing for H. pylori is not recommended in chronic ITP.

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Source: Neunert C., Terrell D. R., Arnold D. M. et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv 2019 Dec 10; 3 (23): 3829−3866, doi: 10.1182/bloodadvances.2019000966.