Am Fam Physician. 1996 Dec;54(8):2437-47, 2451-2.
The American Society of Hematology established a panel to develop practice guidelines for the diagnosis and management of idiopathic thrombocytopenic purpura and to document the extent to which the recommendations are based on either scientific evidence or opinion. A comprehensive literature review found little high-quality scientific evidence to define the natural history of idiopathic thrombocytopenic purpura or to assess the efficacy of diagnostic tests and treatments for the disorder. Recommendations were therefore based on opinion, derived from a formal scoring procedure. In the panel's opinion, in most cases only a history, physical examination and complete blood cell count with examination of the peripheral blood smear are necessary in the routine work-up of patients with suspected idiopathic thrombocytopenic purpura. The panel suggests different treatment approaches in children and adults because of important differences in the behavior of the disease in the two patient groups. The panel recommends that idiopathic thrombocytopenic purpura accompanied by severe bleeding be treated with glucocorticoids, intravenous immunoglobulin and other measures, but that treatment and hospitalization are often unnecessary when patients have only mild to moderate thrombocytopenia or minimal bleeding. Idiopathic thrombocytopenic purpura in pregnant women and the risk of thrombocytopenia in their newborns pose specific problems for diagnosis and treatment.
美国血液学会成立了一个小组，以制定特发性血小板减少性紫癜诊断和管理的实践指南，并记录这些建议基于科学证据或观点的程度。全面的文献综述发现，几乎没有高质量的科学证据来界定特发性血小板减少性紫癜的自然病程，或评估该疾病诊断测试和治疗的疗效。因此，建议基于通过正式评分程序得出的观点。该小组认为，在大多数情况下，对于疑似特发性血小板减少性紫癜的患者，常规检查仅需病史、体格检查及全血细胞计数并检查外周血涂片。由于该疾病在儿童和成人两组患者中的表现存在重要差异，该小组建议采用不同的治疗方法。该小组建议，伴有严重出血的特发性血小板减少性紫癜应采用糖皮质激素、静脉注射免疫球蛋白及其他措施进行治疗，但当患者仅有轻度至中度血小板减少或轻微出血时，通常无需治疗和住院。孕妇的特发性血小板减少性紫癜及其新生儿血小板减少的风险给诊断和治疗带来了特殊问题。
