Introduction: Primary immune thrombocytopenia (pITP) is an acquired autoimmune disorder related with increased destruction or/and impaired production of platelets. Diagnosis and management of ITP is challenging and require expertise and interpretation of international consensus reports and guidelines with national variations of availability. We aimed to assess the agreement of hematologists in Türkiye on certain aspects of both first line and second line management of patients with pITP.
Methods: As a modified Delphi method, Turkish National ITP Working Group (14 steering committee members) founded under Turkish Society of Hematology (TSH) developed a 21-item questionnaire consisting of statements regarding diagnosis-first line and second line treatments of pITP and 107 adult Hematologists working either in university or state hospitals voted for their agreement or disagreement of the statements for two consequential rounds.
Results: Participants have reached consensus on the use of corticosteroids as first line treatment and with limited duration. Methylprednisolone was the choice of corticosteroids rather than dexamethasone. Use of intravenous immunoglobulin was not preferred in patients without bleeding. It was also agreed that thrombopoietin receptor antagonists (TPO-RA) or rituximab should be recommended as second-line treatment, and that splenectomy could be considered 12-24 months after diagnosis in chronic pITP patients.
Conclusion: The optimization of the dose and duration of cortTPO-RAs in addition to corticosteroids is necessary to improve the management of patients with pITP.
Keywords: Adult primary immune thrombocytopenia; Delphi method; Management.