ISTH 2023 | Persistent isolated mild thrombocytopenia: novel clinical guidance statement

Persistent isolated mild thrombocytopenia is a very, very common clinical problem. Primary care providers see these patients, don’t exactly know what to do with them. They have a platelet count between 100 and 149,000, so slightly reduced, its persistence. It’s isolated in that they don’t have other blood counts that are affected, just the platelets. They sometimes get referred to hematology specialists, sometimes not. Often the hematology specialists don’t exactly know what to do with them because it’s a mild problem. But what does it mean? Does it portend some problem in the future? Actually, some work that we did recently actually suggests that it may, that these patients appear to be at significantly increased risk of immune thrombocytopenia as well as the development of hematologic malignancies. We understand that in this relatively large population of patients with persistent isolated thrombocytopenia, there are patients who have clonal abnormalities in their hematopoiesis, there are patients that have hereditary thrombocytopenia syndromes, there are patients that have a sort of forme fruste of ITP, an early immune thrombocytopenia kind of state. But the real conundrum is these patients are so common, do we spend the money and the time to work up every single one of them with NGS panels and looking for hereditary thrombocytopenias and all of this? And that’s what the creation of the clinical guidance statement is about. So as co-chair of the Platelet Immunology SSC subcommittee here at ISTH, we’re going to discuss what we can do in terms of developing a guidance statement in this based on the data that we have, understanding that, you know, there’s still more that needs to be learned about this. And you know, no guidance is perfect, but right now there is no guidance at all. And so we may have enough data at this point, we do have enough data at this point to say something about it.