ASH Clinical News ACN_3.13_FULL_ISSUE_DIGITAL | Page 27

ADVERTISEMENT Chronic ITP: Treating the whole patient Immune thrombocytopenia (ITP): Recognizing the risk ITP is a rare but dangerous illness. Patients with a diagnosis of ITP will face up to a 50% increase in morbidity/mortality risk vs non-ITP patients. 1 To make matters worse, ITP often becomes chronic, affl icting two-thirds of patients for the rest of their lives. 2 Yet one statistic may be more troubling than any other: roughly a third of elderly patients are diagnosed with ITP by chance during a blood screen, either for another illness or preoperatively. 3 The rarity of and risk associated with this disease highlight the value of knowing what ITP looks like at a glance. Common signs and symptoms of ITP include fatigue, oral bleeds, petechiae, purpura, and bruising. 4 Diagnosing ITP earlier—or even knowing its signs and symptoms—may help minimize bleeding and help improve patients’ quality of life. Beyond symptomatology It should be noted that, although the signs and symptoms may not present at low platelet levels, patients are still in danger of severe or uncontrolled bleeds and hospitalization if injured secondarily. 3,5 Therefore, it would be hard to overemphasize the importance of knowing when to suspect ITP. If a patient is older than 56 years of age and suffering frequent bruising and/or bleeds, it is a tell-tale sign of ITP. 1 If already assessing platelet levels, a count below 50 x 10 9 /L should be of concern; and if platelet levels fall to 30 x 10 9 /L, a patient may be at high risk of a bleeding event. 1 If patients should present with bruising or other signs or symptoms of anemia, it may be helpful to test for ITP when requesting bloodwork. Treating the whole patient The lifelong duration and severity of chronic ITP adversely affect more than patients’ risk of morbidity/mortality: they diminish quality of life. 1,6-9 Patients with ITP self-reported a disability weight* comparable to severe anemia, uncontrolled asthma, stage 4 chronic kidney disease, and anxiety disorder in the Global Burden of Disease study. 9 Chronic ITP Severe anemia Uncontrolled asthma Stage 4 chronic kidney disease Anxiety disorder 0.050 0.100 0.150 0.200 0.250 The American Society of Hematology (ASH) guidelines state that the goal of any ITP treatment is to achieve a platelet count that prevents major bleeding. 10† With this single, precise therapeutic goal, physicians have a framework for addressing both the physical and psychological health of patients: although improving outcomes versus morbidity risk is an obvious goal of treatment, studies also show that fl uctuating platelet counts cause many patients to live in fear of a bleeding event, which negatively affects their quality of life. 6-8 By meeting the conditions of this ASH guideline, it may be possible to ease the often underestimated emotional burdens of ITP. 6-9 Achieving and maintaining a healthy platelet count may help change a dangerous situation into a manageable condition for patients, in more ways than one. For more information, visit www.ITPgoals.com. *Health levels associated with nonfatal outcomes, self-assessed by patients. † As released in 2011. References: 1. Khan M, Mikhael J. A review of immune thrombocytopenic purpura: focus on the novel thrombopoietin agonists. J Blood Med. 2010;1:21-31. 2. Moulis G, Palmaro A, Montastruc J-L, Godeau B, Lapeyre-Mestre M, Sailler L. Epidemiology of incident immune thrombocytopenia: a nationwide population-based study in France. Blood. 2014;124(22):3308-3315. 3. Provan D, Newland AC. Current management of primary immune thrombocytopenia. Adv Ther. 2015;32(10):875-887. 4. Indiana Hemophilia and Thrombosis Center. Immune thrombocytopenic purpura (ITP): a new look at an old disorder. Blood Type. Spring 2010:1-6. 5. Provan D, Stasi R, Newland AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010; 115(2):168-186. 6. McCrae K. Immune thrombocytopenia: no longer ‘idiopathic.’ Cleve Clin J Med. 2011;78(6):358-373. 7. Stasi R, Evangelista ML, Stipa E, Buccisano F, Venditti A, Amadori S. Idiopathic thrombocytopenic purpura: current concepts in pathophysiology and management. Thromb Haemost. 2008;99(1):4-13. 8. Brown TM, Horblyuk RV, Grotzinger KM, Matzdorff AC, Pashos CL. Patient-reported treatment burden of chronic immune thrombocytopenia therapies. BMC Blood Disord. 2012;12:2. 9. Salomon JA, Haagsma JA, Davis A, et al. Disability weights for the Global Burden of Disease 2013 study. Lancet Glob Health. 2015;3(11):e712-e723. 10. Neunert C, Lim W, Crowther M, Cohen A, Solberg L Jr, Crowther MA; American Society of Hematology. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011;117(16):4190-4207. Novartis Pharmaceuticals Corporation East Hanover, New Jersey 07936-1080 © 2017 Novartis Printed in USA 9/17 TCT-1173887