Do we need local guidelines for the diagnosis and management of immune thrombocytopenia in Iraq?
Ahmed Mjali1, Bassam Francis Matti2, Nareen Tawfeeq Abbas3, Hassan Ali Abood Nassrullah4, Alaadin Sahham Naji5, Alaa Fadhil Alwan6, Waseem Fadhil Al-Tameemi7, Haider Hasan Jaleel Al-Shammari8, Tareq Abdullah Saleh2, Mohammed Kamil Al Qayyim2, Amer Shareef Mohammed9
1 Department of Hematology/Oncology, Al-Hussein Medical City, Karbala, Iraq
2 Department of Hematology, Baghdad Teaching Hospital, Medical City, Baghdad, Iraq
3 Department of Hematology, Hiwa Hematology/Oncology Hospital, Sulaymaniyah, Iraq
4 Department of Internal Medicine, College of Medicine, University of Al-Ameed, Karbala, Iraq
5 Department of Hematology, Baghdad Medical College, Baghdad University, Baghdad, Iraq
6 Department of Clinical Hematology, The National Center of Hematology, Mustansiriyah University, Baghdad, Iraq
7 Department of Medicine, Hematology Unit, College of Medicine, Al Nahrain University, Baghdad, Iraq
8 Department of Pathology, Baghdad University College of Medicine, Baghdad, Iraq
9 Department of Internal Medicine, Thi.Qar Medical College, Thi-Qar University, Nasiriyah, Iraq
Dr. Ahmed Mjali
Department of Hematology/Oncology, Al- Hussein Medical City, Karbala
Source of Support: None, Conflict of Interest: None
AIMS: Immune thrombocytopenia (ITP), also known as immune thrombocytopenic purpura, is an autoimmune disorder characterized by a low platelet count in the blood. This study aimed to assess the health infrastructure in Iraq regarding the diagnosis and management of patients with immune thrombocytopenia (ITP), with a focus on the use of guidelines in ITP management.
SETTINGS AND DESIGN: This was a cross-sectional study carried out between October and November 2022 to assess ITP diagnosis, management, and the use of guidelines in 18 governorates in Iraq.
MATERIALS AND METHODS: Invited to this study were 79 hematologists who were registered in the Iraqi Society of Hematology and who practiced in the 18 governorates. Out of the 79 hematologists, 65 participated in this survey. Data were collected using a questionnaire.
STATISTICAL ANALYSIS USED: IBM SPSS 28 for Windows was used for the analysis and Microsoft Excel was used for creating the graphs. Descriptive statistics were presented in the form of numbers and percentages as all variables were categorical.
RESULTS: The most requested routine tests were manual assessment of platelet count (83.1%), blood film (98.5%), virology screen (90.9%), connective tissue screen (85.9%), and prothrombin time and partial thromboplastin time (78.5%). More than 80% of the hematologists request bone marrow aspiration for the patients who have no response to the first-line treatment. Only the genetic test and the quantitative immunoglobulin level testing were available in the private sector both by (100%), while the other tests were available in both sectors. More than 85% treat the patients as outpatients. Active bleeding, not platelet count, was the indication for hospitalization for 60% of the hematologists. Corticosteroids were chosen as the first choice as initial treatment by (93.8%), intravenous immunoglobulin the second choice by (6.2%). In the second-line treatment, rituximab was chosen as the first choice by (75.3%), and eltrombopag as the second choice (65%). Only 83% of the hematologists referred to a guideline, and the American Society of Hematology guideline was the most referred to.
CONCLUSIONS: These results showed the need to establish national guidelines for the Diagnosis and Management of Immune Thrombocytopenia in Iraq to be able to effectively treat the laboratory findings and physical symptoms of ITP in addition to address the patient's emotional and mental health needs.