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New guidelines
- JJ
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- JJ
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- mrsb04
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- ITP since 2014. Retired nurse. My belief is empower patients to be involved as much as possible in their care. Read, read, read & ALWAYS question medics about the evidence base they use.
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Sounds absolute heaven. 5 years I've had ITP and still tapering. Down to 1mg/day now.
Very comprehensive guidelines, well referenced and well presented.
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- Hal9000
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- Give me all your platelets and nobody gets hurt
Need to read through the whole thing. On skimming, I'm a little disappointed they didn't go into detail about why a TPO diagnostic test is, or is not, helpful. As I recall from the relevant study, TPO level predicts TPO-RA dosage - which aligns with my ITP treatments table. Maybe I missed it in the document.
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- NK18
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- Hal9000
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- Give me all your platelets and nobody gets hurt
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- Hal9000
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- Give me all your platelets and nobody gets hurt
- Noting that
"vitamin B12 and Folate deficiency can result in thrombocytopenia"
is useful and enlightening
- No discussion on Promacta doses greater than 75mg (new for 2019?)
- This footnote referenced sentence:
"a prospective case-control study found no increased incidence of ITP following vaccination (evidence level IIb)"
contradicts the rest of the paragraph on "Testing for other acute and persistent infections"
- No mention that TPO level is a cursory predictor of TPO-RA dose. This information would allow skipping to higher Nplate doses when appropriate. Low TPO level indicates low TPO-RA dose. Normal level indicates medium dose. High level indicates high dose required.
- On IVIG studies:
"Two have found a reduced IVIg response in patients with only anti–GPIb-IX antibodies."
Well, that's a good start. How about studying those that achieve remission via TPO-RA treatment only? That they are the folks who have poor IVIG responses.
- This assertion on children, I think from what I've seen around here, is true for adults as well:
"Two studies have indicated that response to rituximab is correlated with steroid response (P = .002) (evidence level IIb)"
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