Rodeghiero et al reported criteria for immune thrombocytopenic purpura (ITP) that is refractory to therapy. The authors are from multiple institutions in North America and Europe.
Patient selection: immune thrombocytopenic purpura in adult or pediatric patient, status post initiation of appropriate therapy
Criteria for refractoriness to therapy - all of the following:
(1) at least one of the following:
(1a) failure to achieve at least a response to therapy (platelet count >= 30,000 per µL AND >= 2-fold increase from baseline AND absence of bleeding)
(1b) loss of response after splenectomy
(2) need of therapy to minimize clinically significant bleeding
(3) primary ITP confirmed by excluding other causes of thrombocytopenia (i.e., failure of response not due to another cause)
where:
• Therapy to prevent significant bleeding may include low-dose corticosteroids.
• The use of on-demand or adjunctive therapy alone does not fulfill the criterion #2.
• The criterion for relapse after splenectomy may not be applicable ot children or if an accessory spleen is present.
