Diagnosis and treatment of idiopathic thrombocytopenic purpura: recommendations of the American Society of Hematology. The American Society of Hematology ITP Practice Guideline Panel.
Diagnosis and treatment of idiopathic thrombocytopenic purpura: recommendations of the American Society of Hematology. The American Society of Hematology ITP Practice Guideline Panel.
复制标题
特发性血小板减少性紫癜的诊断和治疗：美国血液学会的建议。
作者：
Z. Tian;S. Cui;S. Pu
为了制定特发性血小板减少性紫癜(ITP)的诊断和治疗指南，并记录这些指南基于科学证据或意见的程度，美国血液学会成立了一个小组，由13名在ITP方面具有专业知识的血液学家、临床流行病学家和实践指南方法学家组成。对所有符合明确纳入标准并评估ITP自然病史或ITP检测和治疗方案的有效性的已发表英文研究进行了全面审查。每项研究的质量由两名评价者使用正式的方法学规则进行评分。在数据不充分的主题领域，建议是根据意见提出的，并通过正式筛选程序得出。保密问卷被用来调查小组中的血液学家关于数百种临床情景下检测和治疗方案的适当性。实践建议是根据每个适应症的平均适宜性分数得出的。投票是保密的，以给予每个小组成员平等的发言权，并限制由群体动态引入的偏见。这些建议经过了八名外部专家的同行审查。这份报告侧重于数据和对成人ITP的建议。几乎没有高质量的科学证据来评估ITP诊断测试和治疗的有效性。专家小组的意见是，在怀疑患有ITP的患者的常规检查中，大多数诊断测试是不必要的，ITP合并严重出血需要使用糖皮质激素、静脉注射免疫球蛋白和其他措施进行治疗。然而，当患者只有轻微或中度的血小板减少症或少量出血时，通常不需要治疗和住院。患有ITP的孕妇有时需要采取特殊的治疗措施。
To develop guidelines for the diagnosis and management of idiopathic thrombocytopenic purpura (ITP) and to document the extent to which those guidelines are based on either scientific evidence or opinion, the AMerican Society of Hematology established a panel composed of 13 hematologists with expertise in ITP, a clinical epidemiologist, and a practice guidelines methodologist. A comprehensive review was done of all published English-language studies that met explicit inclusion criteria and that evaluated the natural history of ITP or the effectiveness of testing and treatment options for ITP. The quality of each study was graded by two reviewers using formal methodologic rules. In subject areas for which data was inadequate, recommendations were based on opinion and were derived by using a formal screening procedure. Confidential questionnaires were used to survey the hematologists on the panel about the appropriateness of testing and treatment options in hundreds of clinical scenarios. Practice recommendations were derived from the mean appropriateness scores for each indication. Voting was kept confidential to give each panel member an equal voice and to limit biases introduced by group dynamics. The recommendations were peer reviewed by eight outside experts. This report focuses on data and on recommendations for adults with ITP. Little high-quality scientific evidence with which to assess the efficacy of diagnostic tests and treatments for ITP is available. The opinion of the panel was that most diagnostic tests are unnecessary in the routine work-ups of patients suspected of having ITP and that ITP accompanied by severe bleeding requires treatment with glucocorticoids, intravenous immunoglobin, and other measures. However, treatment and hospitalization is often unnecessary when patients have only mild or moderate thrombocytopenia or minimal bleeding. Special therapeutic measures are sometimes indicated in pregnant women with ITP.