ITP Publications

1. A description of ITP for patients:

ITP--What it Means to you. American Family Physician (AFP), December, 1996. [Full Text]

2. This Practice Guideline remains a definitive review of the definition, diagnosis, management and outcomes of ITP in children and adults

George, JN, Woolf, SH, Raskob, GE, Wasser J, Aledort LM, Ballem PJ, Blanchette VS, Bussel JB, Cines DB, Kelton JG, Lichtin AE, McMillan R, Okerbloom JA, Regan DH, Warrier I. Idiopathic Thrombocytopenic Purpura: A Practice Guideline Developed by Explicit Methods for The American Society of Hematology. Blood 88:3-40, 1996. [Full Text]

3. A summary of the definition, diagnosis, and management of ITP.

George JN: Definition, diagnosis, and management of immune thrombocytopenic purpura in adults. Haematologica 94: 759-762, 2009. [Full Text]

4. A systematic critical assessment of data on the incidence of ITP in children and adults.

Terrell DR, Beebe LA, Vesely SK, Neas BR, Segal JB, George JN: The incidence of immune thrombocytopenic purpura in children and adults. A critical review of published reports. American J Hematol 85(3): 174-180, 2010. [Full Text]

5. To understand the current practice for management of patients with ITP, as survey of Oklahoma primary care clinicians documented the common criteria used for referral of patients with thrombocytopenia to hematologists.

Terrell DR, Beebe LA, George JN, Vesely SK, Mold JW: Referral of patients with thrombocytopenia from primary care clinicians to hematologists. Blood 113: 4126-4127, 2009. [Full Text]

6. These surveys document the practice of pediatric hematologists who treat children with ITP. Although most US pediatric hematologists treat children with anti-D, IVIG, or steroids, most European pediatric hematologists feel that observation without specific treatment is better.

Vesely SK, Buchanan GR, George JN, Roskob GE, Cohen A: Self-reported initial management approaches for childhood idiopathic thrombocytopenic purpura: results of a survey of The American Society of Pediatric Hematology and Oncology. J Pediatr Hematol Oncol 22: 55-61, 2000. [Full Text]

Vesely SK, Buchanan GR, Adix L, George JN, Cohen AR, Blanchette VS, Kuhne T: Self-reported initial management of childhood idiopathic thrombocytopenic purpura: results of a survey of members of the American Society of Pediatric Hematology/Oncology – 2001. J Pediatric Hematol/Oncol 25: 130-133, 2003. [Full Text]

7. These discussions describe the different opinions about the best management for children with a new diagnosis of ITP.

Bolton-Maggs P, Tarantino MD, Buchanan GR, Bussel JB, George JN: The child with ITP: is pharmacotherapy or watchful waiting the best initial management? A panel discussion from the 2002 ASPH/O meeting. J Pediatric Hematol/Oncol 26: 146-151, 2004. [Full Text]

George JN: Initial management of immune thrombocytopenic purpura (ITP) in children: is supportive counseling without therapeutic intervention sufficient? J Pediatrics 137:598-600,2000. [Full Text]

8. The toxicities of steroid treatment of ITP are a major problem for patients but underestimated by their hematologists. Part of the reason may be the hematologists are more concerned about the risk for serious bleeding than the patients.

Guidry J, George JN, Vesely SK, Kennison SM, Terrell DR: Corticosteroid side effects and risk for bleeding in immune thrombocytopenic purpura: patient and hematologist perspectives. European J Haematol 83: 175-182, 2009. [Full Text]

Guidry J, Watson S, George JN, Vesely SK, Terrell DR: Addendum to corticosteroid side effects in immune thrombocytopenic purpura: patient perspectives. European J Haematol 83: 497-498, 2009. [Full Text]

9. A systematic review of all case series reporting 15 or more patients that were published since 1966 and described splenectomy as treatment for ITP.

The review focuses on 3 questions: [1] Can any test or observation predict the success of splenectomy? [2] What are the risks of splenectomy? [3] What is the frequency of a durable, good response to splenectomy?

Kojouri K, Vesely SK, Terrell DR, George JN: Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systemic review to assess long-term platelet count responses, prediction of responses, and surgical complications. Blood 104: 2623-2634, 2004. [Full Text]

10. A systematic review of all reports describing treatments used for patients with ITP who have failed to respond to splenectomy. This review documents how few patients have actually been described for any treatment; this observation explains why we are uncertain what is the best treatment for these patients.

Vesely SK, Purdue JJ, Rizvi MA, Terrell DR, George JN: Management of adult patients with persistent idiopathic thrombocytopenic purpura following splenectomy. A systematic review. Ann Int Med 140: 112-120, 2004. [Full Text]

11. A review of current management for patients with refractory ITP.

George JN: Management of refractory immune thrombocytopenic purpura. J Thromb Haemost 4: 1664-1672, 2006. [Full Text]

12. New agents that simulate the hormone, thrombopoietin and stimulate platelet production, romiplostim (Nplate) and eltrombopag (Promacta), are very effective in patients with ITP that is refactory to conventional treatments with steroids and splenectomy. These articles provide some of the data from the clinical trials for the development of these agents and a summary of their role related to splenectomy.

Bussel JB, Kuter DL, George JN, McMillan R, Aledort LM, Conklin GT, Lichtin AE, Lyons RM, Nieva J, Wasser JS, Wiznitzer I, Kelly R, Chen C-F, Nichol JL: AMG 531, a thrombopoiesis-stimulating protein, for chronic ITP. New Eng J Med 355: 1672-1681, 2006. [Full Text]

Kuter DJ, Bussel JB, Lyons RM, Pullarkat V, Gernsheimer TB, Senecal FM, Aledort LM, George JN, Kessler CM, Sanz MA, Liebman HA, Slovick FT, de Wolf JThM, Bourgeois E, Guthrie TH, Newland A, Wasser JS, Hamburg SI, Grande C, Lefrere F, Lichtin AE, Tarantino MD, Terebelo HR, Viallard JF, Cuevas FJ, Go RS, Henry DH, Redner RL, Rice L, Schipperus MR, Guo DM, Nichol J:  Efficacy of romiplostim in patients with chronic immune thrombocytopenic pupura: a double-blind randomized controlled trial.  Lancet 371: 395-403, 2008. [Full Text]

George JN, Terrell DR: Novel thrombopoietic agents: a new area for management of patients with thrombocytopenia. Haematologica 93: 1445-1449, 2008. [Full Text]

George JN, Mathias SD, Go RS, Guo M, Henry DH, Lyons RM, Redner RL, Rice L, Schipperus MR: Improved quality of life for romiplostim-treated patients with chronic immune thrombocytopenic purpura: results from two randomized, placebo-controlled trials. Brit J Haematol 144: 409-415, 2009. [Full Text]

George JN: Management of immune thrombocytopenia - something old, something new. New Eng J Med 363(20): 1959-1961, 2010. [Full Text]

13.  In addition to the apparent bleeding symptoms, patients with ITP have significant problems with the quality of their lives, described by a new questionnaire designed specifically for adults with ITP.

Mathias SD, Gao SK, Miller KL, Cella D, Snyder C, Turner R, Wu A, Bussel JB, George JN, McMillan R, Wysocki DK, Nichol JL:  Impact of Immune thrombocytopenic purpura (ITP) on health-related quality of life: a conceptual model starting with the patient perspective.  Health and Quality of Life Outcomes 6: 13-27, 2008. [Full Text]


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