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Primary immune thrombocytopenia (ITP) is a common bleeding disorder in children, and China is a country with a high incidence of ITP
.
In recent years, international authoritative organizations and the American Society of Hematology have successively published ITP diagnosis and treatment guidelines
.
Experts in the field of children's blood in China also issued the "Guidelines for the Diagnosis and Treatment of Chinese Children with Primary Immune Thrombocytopenia (2021 Edition) [1]" in October 2021, aiming to provide clinical diagnosis of Chinese children with ITP And treatment provides evidence-based basis to further standardize clinical diagnosis and treatment
.
Yimaitong invited Professor Hu Qun from Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology to accept an interview to interpret the latest children's ITP guidelines and share their experience in clinical treatment of children's ITP
.
The background and significance of the new guidelines for children's ITP is the most common primary immune thrombocytopenia in childhood
.
China has a vast territory, a large population, unbalanced economic development, and different levels of treatment in hospitals across the country.
Therefore, ITP treatment must be standardized, otherwise it will go its own way
.
Although China issued two expert consensuses on ITP for children in 2013 and 2019, the treatment concept is constantly changing and evolving over time
.
In 2019, international authorities issued two high-quality guidelines in a row.
However, due to differences in factors such as culture, social background, resources, race, and preferences of children or guardians, international guidelines cannot be directly applied to clinical practice in China
.
Therefore, the Hematology Group of the Pediatrics Branch of the Chinese Medical Association and the editorial committee of the Chinese Journal of Pediatrics jointly convened relevant experts to locally adapt the diagnosis and treatment guidelines issued by foreign countries in line with China's national conditions, and standardize the clinical diagnosis and treatment practice of children's ITP in China, which is the clinical practice of ITP in China.
The treatment provides effective, standardized, and specific diagnosis and treatment suggestions
.
Interpretation of the new guidelines: Not all ITPs in children need treatment.
ITP in children is mostly self-limiting.
Treatment measures should mainly refer to bleeding symptoms, not platelet counts
.
Platelet count is only one of the consideration factors for treatment decisions.
Treatment decisions must be made after comprehensive consideration of the bleeding performance of children and the degree of interference in life by the disease
.
The treatment endpoint of ITP is not only to increase the platelet count, but also to stop bleeding, improve the quality of life, and reduce adverse drug reactions
.
The new guideline standardizes the classification of treatment and gives clinicians detailed guidance.
More importantly, compared with the previous guideline, the new guideline incorporates the wishes of patients and their family members.
Compared with previous diagnosis and treatment recommendations and expert consensus, The new guidelines that include patient voices are more comprehensive
.
Interpretation of the new guideline: Recommended treatment plan for children's ITP The first-line treatment plan for children's ITP recommended by the guideline is: glucocorticoid or intravenous immunoglobulin (IVIG)
.
When the first-line treatment of ITP patients is ineffective and treatment is still needed, they will enter the second-line treatment.
The general drugs for the second-line treatment include thrombopoiesis drugs and rituximab.
In addition, splenectomy can be used
.
The selection of treatment options for children should pay attention to safety.
The adverse reactions of thrombopoiesis drugs are less than that of rituximab, and the safety is higher
.
In addition, considering the particularity of pediatric patients, splenectomy is not the first choice in pediatric patients
.
Therefore, compared with rituximab and splenectomy, it is recommended that thrombopoiesis drugs be the first choice for conventional second-line treatment (level Ib evidence, level A recommendation)
.
Standardization is the key to how to improve the level of diagnosis and treatment of children's ITP
.
At present, there are still many irregularities in the treatment of ITP in China, such as undertreatment or overtreatment.
Overtreatment of ITP is very common in clinic, which affects the treatment effect of patients
.
In addition, as the first-line treatment of ITP, adrenal cortex hormones are prone to side effects such as Cushing's syndrome when used irregularly, which seriously affects the quality of life of patients
.
Although ITP is a common bleeding disease in children, it can achieve good therapeutic effects under standardized treatment
.
Therefore, when the new guidelines were revised, they also emphasized the importance of standardized diagnosis and treatment: first, a standardized diagnosis is required, and doctors must realize that not all thrombocytopenias are ITP, and need to be correctly identified in the diagnosis process; secondly, standardized treatment is required after diagnosis However, not all ITPs need treatment, and not all thrombocytopenias need drug intervention.
Doctors need to accurately determine under what circumstances need to wait, observe, and treat
.
Summary China has a vast territory and uneven medical standards.
There are still many irregularities in the treatment of children's ITP.
In order to further improve the level of children's ITP diagnosis and treatment in China, experts in the field of children's blood have issued new guidelines that clarify the treatment goals: more than just To increase the platelet count, it is important to stop bleeding, reduce adverse drug reactions, and improve the quality of life of patients
.
Considering the particularity of children with ITP, in the selection of second-line treatment, compared with rituximab and splenectomy, the guidelines recommend that thrombopoietic drugs are the first choice (level Ib evidence, level A recommendation)
.
To further improve the level of ITP diagnosis and treatment in China, standardization is the key
.
The new version of the guidelines emphasizes that the diagnosis and treatment of children with ITP needs to make decisions after comprehensive consideration of platelet count, bleeding, and the degree of interference in life by diseases, so that patients can live a normal and relatively healthy life under standard treatment
.
Professor Hu Qun Chief physician, professor, and doctoral supervisor of the Pediatric Hematology Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Member of the Pediatrics Society graduated from Tongji Medical University in 1984, and after receiving a master's degree in 1988, he worked in the Department of Pediatrics of Tongji Hospital to engage in clinical, teaching and scientific research.
In 1999, he studied at the Children's Cancer Center of the Prince of Wales Hospital, Chinese University of Hong Kong.
In 2000, he went to Ulm University Hospital, Germany.
He studied in the Oncology Laboratory and the Department of Clinical Chemistry and Pathology, and obtained a doctorate degree.
In 2002, he returned to China and his main research directions were the basic and clinical references of childhood blood/tumor diseases and childhood coagulation diseases: [1] Chinese children's primary immunity Working Group on Adaptation of Guidelines for Diagnosis and Treatment of Thrombocytopenia, Hematology Group of Pediatric Branch of Chinese Medical Association, Editorial Committee of Chinese Journal of Pediatrics.
Adaptation Guidelines for Diagnosis and Treatment of Chinese Children with Primary Immune Thrombocytopenia (2021 Edition)[J].
Chinese Journal of Pediatrics, 2021, 59(10):810-819.
The MCC number REV21111424 is valid from 2022-11-17, and the information is expired and deemed invalid
.
This information is for academic reference only by medical and health professionals, please do not distribute or forward it
.
This indication has not been approved in China, and the relevant content is for academic exchanges only
.
Poke "read the original text", we make progress together
.
In recent years, international authoritative organizations and the American Society of Hematology have successively published ITP diagnosis and treatment guidelines
.
Experts in the field of children's blood in China also issued the "Guidelines for the Diagnosis and Treatment of Chinese Children with Primary Immune Thrombocytopenia (2021 Edition) [1]" in October 2021, aiming to provide clinical diagnosis of Chinese children with ITP And treatment provides evidence-based basis to further standardize clinical diagnosis and treatment
.
Yimaitong invited Professor Hu Qun from Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology to accept an interview to interpret the latest children's ITP guidelines and share their experience in clinical treatment of children's ITP
.
The background and significance of the new guidelines for children's ITP is the most common primary immune thrombocytopenia in childhood
.
China has a vast territory, a large population, unbalanced economic development, and different levels of treatment in hospitals across the country.
Therefore, ITP treatment must be standardized, otherwise it will go its own way
.
Although China issued two expert consensuses on ITP for children in 2013 and 2019, the treatment concept is constantly changing and evolving over time
.
In 2019, international authorities issued two high-quality guidelines in a row.
However, due to differences in factors such as culture, social background, resources, race, and preferences of children or guardians, international guidelines cannot be directly applied to clinical practice in China
.
Therefore, the Hematology Group of the Pediatrics Branch of the Chinese Medical Association and the editorial committee of the Chinese Journal of Pediatrics jointly convened relevant experts to locally adapt the diagnosis and treatment guidelines issued by foreign countries in line with China's national conditions, and standardize the clinical diagnosis and treatment practice of children's ITP in China, which is the clinical practice of ITP in China.
The treatment provides effective, standardized, and specific diagnosis and treatment suggestions
.
Interpretation of the new guidelines: Not all ITPs in children need treatment.
ITP in children is mostly self-limiting.
Treatment measures should mainly refer to bleeding symptoms, not platelet counts
.
Platelet count is only one of the consideration factors for treatment decisions.
Treatment decisions must be made after comprehensive consideration of the bleeding performance of children and the degree of interference in life by the disease
.
The treatment endpoint of ITP is not only to increase the platelet count, but also to stop bleeding, improve the quality of life, and reduce adverse drug reactions
.
The new guideline standardizes the classification of treatment and gives clinicians detailed guidance.
More importantly, compared with the previous guideline, the new guideline incorporates the wishes of patients and their family members.
Compared with previous diagnosis and treatment recommendations and expert consensus, The new guidelines that include patient voices are more comprehensive
.
Interpretation of the new guideline: Recommended treatment plan for children's ITP The first-line treatment plan for children's ITP recommended by the guideline is: glucocorticoid or intravenous immunoglobulin (IVIG)
.
When the first-line treatment of ITP patients is ineffective and treatment is still needed, they will enter the second-line treatment.
The general drugs for the second-line treatment include thrombopoiesis drugs and rituximab.
In addition, splenectomy can be used
.
The selection of treatment options for children should pay attention to safety.
The adverse reactions of thrombopoiesis drugs are less than that of rituximab, and the safety is higher
.
In addition, considering the particularity of pediatric patients, splenectomy is not the first choice in pediatric patients
.
Therefore, compared with rituximab and splenectomy, it is recommended that thrombopoiesis drugs be the first choice for conventional second-line treatment (level Ib evidence, level A recommendation)
.
Standardization is the key to how to improve the level of diagnosis and treatment of children's ITP
.
At present, there are still many irregularities in the treatment of ITP in China, such as undertreatment or overtreatment.
Overtreatment of ITP is very common in clinic, which affects the treatment effect of patients
.
In addition, as the first-line treatment of ITP, adrenal cortex hormones are prone to side effects such as Cushing's syndrome when used irregularly, which seriously affects the quality of life of patients
.
Although ITP is a common bleeding disease in children, it can achieve good therapeutic effects under standardized treatment
.
Therefore, when the new guidelines were revised, they also emphasized the importance of standardized diagnosis and treatment: first, a standardized diagnosis is required, and doctors must realize that not all thrombocytopenias are ITP, and need to be correctly identified in the diagnosis process; secondly, standardized treatment is required after diagnosis However, not all ITPs need treatment, and not all thrombocytopenias need drug intervention.
Doctors need to accurately determine under what circumstances need to wait, observe, and treat
.
Summary China has a vast territory and uneven medical standards.
There are still many irregularities in the treatment of children's ITP.
In order to further improve the level of children's ITP diagnosis and treatment in China, experts in the field of children's blood have issued new guidelines that clarify the treatment goals: more than just To increase the platelet count, it is important to stop bleeding, reduce adverse drug reactions, and improve the quality of life of patients
.
Considering the particularity of children with ITP, in the selection of second-line treatment, compared with rituximab and splenectomy, the guidelines recommend that thrombopoietic drugs are the first choice (level Ib evidence, level A recommendation)
.
To further improve the level of ITP diagnosis and treatment in China, standardization is the key
.
The new version of the guidelines emphasizes that the diagnosis and treatment of children with ITP needs to make decisions after comprehensive consideration of platelet count, bleeding, and the degree of interference in life by diseases, so that patients can live a normal and relatively healthy life under standard treatment
.
Professor Hu Qun Chief physician, professor, and doctoral supervisor of the Pediatric Hematology Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Member of the Pediatrics Society graduated from Tongji Medical University in 1984, and after receiving a master's degree in 1988, he worked in the Department of Pediatrics of Tongji Hospital to engage in clinical, teaching and scientific research.
In 1999, he studied at the Children's Cancer Center of the Prince of Wales Hospital, Chinese University of Hong Kong.
In 2000, he went to Ulm University Hospital, Germany.
He studied in the Oncology Laboratory and the Department of Clinical Chemistry and Pathology, and obtained a doctorate degree.
In 2002, he returned to China and his main research directions were the basic and clinical references of childhood blood/tumor diseases and childhood coagulation diseases: [1] Chinese children's primary immunity Working Group on Adaptation of Guidelines for Diagnosis and Treatment of Thrombocytopenia, Hematology Group of Pediatric Branch of Chinese Medical Association, Editorial Committee of Chinese Journal of Pediatrics.
Adaptation Guidelines for Diagnosis and Treatment of Chinese Children with Primary Immune Thrombocytopenia (2021 Edition)[J].
Chinese Journal of Pediatrics, 2021, 59(10):810-819.
The MCC number REV21111424 is valid from 2022-11-17, and the information is expired and deemed invalid
.
This information is for academic reference only by medical and health professionals, please do not distribute or forward it
.
This indication has not been approved in China, and the relevant content is for academic exchanges only
.
Poke "read the original text", we make progress together
