GUIDELINES FOR DIAGNOSTICS AND TREATMENT OF PRIMARY IMMUNE THROMBOCYTOPENIA IN ADULTS
Silva Zupančić-Šalek, Dražen Pulanić, Slobodanka Ostojić-Kolonić, Vlatko Pejša, Toni Valković, Damir Nemet
Working Group for Diseases of Hemostasis and Thrombosis of the Croatian Cooperative Group for Hematologic Diseases (CROHEM), Referral Center for Hereditary and Acquired Disorders of Hemostasis of the Croatian Ministry of Health, and Croatian Hematology Society of the Croatian Medical Association developed the Croatian guidelines for the diagnosis and treatment of primary immune thrombocytopenia (ITP). Detailed clinical and laboratory examination should be performed to exclude common secondary causes of thrombocytopenia. An individualized therapeutic approach is proposed, and decision to start active treatment depends on the severity and risk of bleeding, platelet count, patient’s life style, age and comorbidities. Glucocorticoids with or without intravenous immunoglobulines are recommended as the first line treatment. The second line treatments are splenectomy or thrombopoietin receptor agonists as suggested options. Thrombopoietin receptor agonists are recommended treatment for splenectomized patients with relapsed ITP. Alternatively rituximab or other immunosuppressive agents are suggested in second or later treatment lines.