免疫性血小板减少症(ITP)是一种常见的自身免疫性血液病。尽管如此,由于临床异质性和缺乏特异性诊断测试,诊断仍然具有挑战性.病理学的新发现和新药的可用性导致了全球不同指南的开发。在本研究中,Delphi方法已被用于就西班牙成人ITP患者的管理达成共识,并有助于决策.德尔菲问卷由科学特设委员会设计,分为13个主题,共有127个项目,涵盖ITP管理的最大可能方案。作为研究的结果,达成了81%的共识。结论是,此Delphi共识就与ITP患者的诊断和管理相关的主题提供了实用建议,以帮助医生改善预后。有些方面还不清楚,专家之间没有共识。因此,需要更多的进步来优化ITP管理。
背景是什么?免疫性血小板减少症(ITP)是一种血液学自身免疫性疾病,其特征是由自身抗体(血小板计数<100×109/L)介导的血小板加速破坏和产生不足。尽管是一种常见的情况,其异质性的临床过程使其诊断和管理仍然是一个挑战。近年来,具有不同作用机制的新分子已经出现用于治疗ITP。由于关于病理学及其治疗的信息越来越多,最近制定了一些国际准则,为ITP的管理和治疗提供建议.仍有许多患者情景和疾病方面未在指南中解决。我们的西班牙ITP专家组开发了一项Delphi共识研究,以提供建议并促进西班牙成年ITP患者管理的标准化。科学委员会确定了127个共识声明,对应13章:(I)ITP的诊断,(二)一线治疗,(三)二线治疗,(四)治疗难治性病人,(五)后续行动,(vi)急诊和手术,(vii)老年人的ITP,(viii)怀孕期间的ITP,(ix)抗凝和抗血小板,(x)二级ITP,(十一)生活质量,(十二)终止TPO-RA,和(十三)ITP和Covid。达成一致的陈述总数为103,在Delphi问卷中最终达成共识的百分比为81%。影响是什么?此Delphi共识基于真实的临床实践数据提供建议,关于诊断,治疗,以及对ITP患者和情况的管理,以帮助临床医生解决这种疾病并为患者实现最佳结果。
Immune thrombocytopenia (ITP) is a common autoimmune hematological disorder. Despite this, diagnosis is still challenging due to clinical heterogeneity and the lack of a specific diagnostic test. New findings in the pathology and the availability of new drugs have led to the development of different
guidelines worldwide. In the present study, the Delphi methodology has been used to get a
consensus on the management of adult patients with ITP in Spain and to help in decision-making. The Delphi questionnaire has been designed by a scientific ad hoc committee and has been divided into 13 topics, with a total of 127 items, covering the maximum possible scenarios for the management of ITP. As a result of the study, a total
consensus of 81% has been reached. It is concluded that this Delphi consensus provides practical recommendations on topics related to diagnosis and management of ITP patients to help doctors to improve outcomes. Some aspects remain unclear, without
consensus among the experts. Thus, more advances are needed to optimize ITP management.
What is the context? Immune thrombocytopenia (ITP) is a hematologic autoimmune disease characterized by accelerated destruction and inadequate production of platelets mediated by autoantibodies (platelet count <100 × 109 /L).Despite being a common condition, its heterogeneous clinical course makes its diagnosis and management still a challenge.In recent years, new molecules with different mechanisms of action have emerged for the treatment of ITP.Due to the increasing information about the pathology and its therapies, several international
guidelines have recently been established to provide recommendations for the management and treatment of ITP.There are still many patient scenarios and disease aspects which are not addressed in the guidelines.What is new? Our Spanish ITP Expert Group has developed a Delphi consensus study to provide recommendations and promote standardization of the management of adult patients with ITP in Spain.The scientific committee defined 127 statements for consensus, corresponding to 13 chapters: (i) Diagnosis of ITP, (ii) First-line treatment, (iii) Second-line treatment, (iv) Treatment of refractory patients, (v) Follow-up, (vi) Emergency and surgery, (vii) ITP in the elderly, (viii) ITP in pregnancy, (ix) Anticoagulation and antiplatelet, (x) Secondary ITP, (xi) Quality of life, (xii) Discontinuation of TPO-RA, and (xiii) ITP and Covid.The total number of agreed statements achieved was 103, giving a final percentage of consensus in the Delphi questionnaire of 81%.What is the impact? This Delphi consensus provides recommendations based on real clinical practice data, regarding the diagnosis, treatment, and management of patients and scenarios in ITP to assist clinicians in addressing this disease and achieving optimal outcomes for the patient.