Criteria

2009 international working group definitions of immune thrombocytopenia (ITP)

The following definitions for ITP have been proposed by an international working group and are used in guidelines:[1][15]

  • Primary ITP: an autoimmune disorder characterized by isolated thrombocytopenia (peripheral blood platelet count <100 × 10⁹/L) in the absence of other causes or disorders associated with thrombocytopenia.

  • Secondary ITP: all forms of immune-mediated thrombocytopenia except primary ITP.

  • Newly diagnosed ITP: within 3 months from diagnosis.

  • Persistent ITP: between 3 and 12 months from diagnosis. Includes patients not reaching spontaneous remission or not maintaining complete response without therapy.

  • Chronic ITP: lasting for more than 12 months.

  • Severe ITP: bleeding symptoms at presentation requiring treatment, or new bleeding symptoms requiring additional therapeutic intervention with a different agent or an increased dose.

Recommendations for target platelet counts before dentistry, surgery, or medical therapy in adults

The exact platelet count needed for any procedure or therapy is unknown, but these consensus-based targets have been proposed as guidance for adults considered to be at “typical” bleeding risk.[15]

  • Dentistry:

    • Dental prophylaxis (descaling, deep cleaning): ≥20-30 × 10³/microliter

    • Simple extractions ≥30 × 10³/microliter

    • Complex extractions ≥50 × 10³/microliter

    • Regional dental block ≥30 × 10³/microliter

  • Minor surgery ≥50 × 10³/microliter

  • Major surgery ≥80 × 10³/microliter

  • Major neurosurgery ≥100 × 10³/microliter

  • Vaginal delivery and cesarean section ≥50 × 10³/microliter

  • Spinal or epidural anesthesia ≥80 × 10³/microliter

  • Single antiplatelet agent or anticoagulant: ≥30-50 × 10³/microliter

  • Dual antiplatelet or anticoagulant: ≥50-70 × 10³/microliter

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