Group A DefinitionsCriteria for primary and secondary ITP

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Group A- Definitions/Criteria for primary and
secondary ITP
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Future research (1)

• Both for children and adult ITP there is a need
  for agreed criteria for diagnosis and exclusion
  of secondary ITP, for staging of the disease and
  for response to therapy.
• At least in children the staging should be based
  on bleeding severity criteria and not on platelet
  counts.

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Important points

• Revisit the diagnostic criteria
• Uniformity between children and adults
• Needs to be simple
• A bleeding score is more important than the
  platelet count
• Criteria for response rate need to be agreed

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Diagnosis

• Full competent history plus proper examination of
  the blood smear
• Must keep thinking about the possible
  differential diagnosis.
• Is a bone marrow examination necessary?
• No agreement in the group
• NOT FOR DISCUSSION TODAY!

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Primary vs Secondary

• Definition of primary
• is ITP in an individual who is otherwise healthy
• vs secondary
• Chronic other disorder in association with ITP

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Chronic ITP should go

• Persistent thrombocytopenia
• When?
• Within three months we re-evaluate the diagnosis
  including the peripheral smear
• Use a check list details to be determined
• Define the appropriate place for a bone marrow
  examination
• Six months?
• A year or more

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How do we proceed

• Expert group will agree criteria - content
  validation
• Criterion validation, ie. Does the content
  actually measure what we think it does?
• Need methodology (e.g. from the haemophilia
  field)
• Involving adult and paediatric haematologists
• Perform the validation by examination of the ICIS
  patient database
• Communicate the results

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Communication of results

• To ISTH, EHA, ASH, BSH.etc
• Paediatric societies because many children are
  not treated by haematologist
• Generalists who treat adults with ITP, eg in
  South America
• Measure the reliability of the criteria in
  clinical use for a defined period
• Re-evaluation