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Year : 2011  |  Volume : 2  |  Issue : 4  |  Page : 284-287

Chronic immune thrombocytopenic purpura (ITP): Three decades of experience

Ain Shams University, Egypt

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Immune thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by a low circulating platelet count caused by the destruction of antibody-sensitized platelets in the reticuloendothelial system. ITP can be classified as childhood or adult, acute or chronic, and primary or secondary. The persistence of ITP beyond 12 months defines the chronic form of the disorder. Essential data in ITP patients included demographic data, disease onset, course and duration, treatment modalities, and patient response to treatment according to the definition of Rodeghiero et al. 1 Previously published guidelines for the diagnosis and management of primary ITP require updating largely owing to the introduction of new classes of therapeutic agents and a greater understanding of disease pathophysiology. Treatment-related decisions still depend principally on clinical expertise or patient preference, however, rather than high-quality clinical trial evidence. This consensus document aims to report new data and provide consensus-based recommendations relating to the diagnosis and treatment of ITP in adults, children, and pregnancy. 2 The secondary causes of ITP, which include collagen vascular disorders, immune deficiencies, and some chronic infections, are less common in children than in adults. This review focuses on the diagnosis and management of children who have chronic ITP. Emphasis is placed on areas of controversy and new therapies. Predictors of chronic ITP were similar to those in western studies; the gradual onset of symptoms over >2 weeks, initial platelet count >20×10 9 /L, and age >10 years at presentation were the major predictors, whereas negative history of preceding febrile illness and less frequent mucosal bleeding were minor predictors in a subset of patients prone to the development of chronic ITP. 3

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