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Iraqi consensus recommendations for the diagnosis and management of immune thrombocytopenia
Ahmed Mjali1, Bassam Francis Matti2, Waleed Ghanima3
1Department of Hematology/Oncology, Al-Hussein Medical City, Karbala, Iraq.
Background And Objectives:
The management of ITP has evolved with evidence-based international guidelines. However, Iraq's unique challenges, including variations in clinical practice and treatment disparities, necessitate localized guidance to bridge global recommendations and real-world practice. This expert consensus aims to provide a comprehensive and practical framework for diagnosing and managing ITP within the Iraqi healthcare setting.
Methods:
A 16-member multidisciplinary ITP specialist panel (Iraq, Norway, UK), including hematologists, laboratory experts, and related specialists, conducted a systematic PubMed / PubMed Central / Embase review (January 2003-December 2024) using key terms 'primary immune thrombocytopenia' and 'idiopathic thrombocytopenic purpura' (English human studies, excluding conference abstracts). Using a modified Delphi method, consensus was reached on 43 ITP diagnosis/treatment/management statements. After a single voting round, the panel refined the recommendations to ensure their applicability to Iraq's healthcare system. Final recommendations were categorized using evidence grading system.
Results:
Corticosteroids were the preferred first-line therapy, with intravenous immunoglobulin (IVIG) reserved for urgent platelet elevation. The panel discouraged prolonged corticosteroid use due to adverse effects and defined clear criteria for second-line therapies. Thrombopoietin receptor agonists (TPO-RAs) and rituximab were recommended second-line, while splenectomy was considered a last resort, only after the failure of multiple medical therapies. Special populations received tailored recommendations, including pregnant patients, pediatric cases, and high-thrombosis-risk individuals. Recommendations incorporated quality of life, emphasizing patient-centered care and minimizing unnecessary medication exposure.
Conclusion:
This expert consensus provides a structured, evidence-informed approach to ITP diagnosis and management in Iraq, balancing best practices with local healthcare realities.
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