These assays lack sufficient sensitivity to exclude a diagnosis of ITP18-20  and interlaboratory reproducibility is inadequate.21. IV anti-D can be substituted for prednisone in Rh+ and direct antiglobulin-negative patients intolerant of corticosteroids or who have contraindications to their use.40,41  Therapy with prednisone can be supplemented with IVIG (1.0 g/kg/d for 1-2 days), IV anti-D (50-75 μg/kg), or IV methylprednisolone (1 g) if platelet counts remain below 20 000 × 109/L or if there is another need for a more rapid response. Copyright © 2005 by The American Society of Hematology, Copyright ©2020 by American Society of Hematology,, Hemostasis, Thrombosis, and Vascular Biology. Aledort LM, Hayward CP, Chen MG, Nichol JL, Bussel J. Although we think that a platelet count of 50 000 × 109/L is generally sufficient for epidural anesthesia, we find practice patterns are set by obstetricians and anestheologists.3,86  Criteria for heparin prophylaxis after cesarean section have been reviewed.3  ITP is not a contraindication to breast-feeding. We test for antiphospholipid antibodies if there is a history thrombosis, recurrent or second- or third-trimester gestational failure, or a prolonged activated partial thromboplastin time.10,16  Up to 5% to 10% of patients eventually meet criteria for systemic lupus erythematosus or another cause of secondary immune thrombocytopenia.17  Our approach to secondary immune thrombocytopenia, including systemic lupus erythematosus, antiphospholipid syndrome, B-cell malignancies (primarily chronic lymphocytic and large granular leukemias), and HIV infection, among others, has been reviewed elsewhere.4, We do not rely on measuring antiplatelet antibodies to make or exclude a diagnosis of ITP. Per maggiori informazioni consultare i seguenti allegati: Sentenza. Patients typically present with petechiae or purpura that develop over several days accompanied by platelet counts less than 20 000 × 109/L, although the onset is often more insidious than previously appreciated.10  Severe cutaneous bleeding, prolonged epistaxis, gingival bleeding, overt hematuria, or menorrhagia may develop at platelet counts less than 10 000 × 109/L. In contrast, some experts recommend a far more protracted period of watchful waiting, with splenectomy reserved for those with a platelet count consistently less than 20 000 × 109/L or in the face of difficult-to-control bleeding.28  Although we might concur with this approach in, for example, a 75-year-old asymptomatic patient with a platelet count of 18 000 × 109/L, a life expectancy of 8 to 12 years, and significant risks from surgery, we think the benefits of splenectomy outweigh the risks in the typical active young adult with easy bruising or significant menorrhagia, a platelet count of 20 000 to 30 000 × 109/L, and a life expectancy of 50 to 60 years whose disease shows no signs of abating. Dopo queste storiche pronunce, la Direzione Nazionale del Sindacato ASSET Scuola ha deciso di aprire i termini di adesione al ricorso per l’inserimento in Gae dei Diplomati ITP fino al Giorno 31 Dicembre 2020 (data di spedizione della documentazione). Contro ogni pronostico è stato affermato il diritto dei Diplomati ITP ad entrare in GAE. Idiopathic thrombocytopenic purpura, neonatal alloimmune thrombocytopenia, and post-transfusion purpura. Diz-Kucukkaya R, Hacihanefioglu A, Yenerel M, et al. Maloisel F, Andres E, Zimmer J, et al. Long-term observation of 208 adults with chronic idiopathic thrombocytopenic purpura. Once a response is seen, corticosteroids can be tapered and IVIG stopped. Those with platelet counts more than 50 000 × 109/L can almost always be observed, although some (5 of 87 in one series7 ) require treatment later. Approximately 1% of patients have coexisting immune hemolytic anemia (Evans syndrome) and a smaller percentage have immune neutropenia, which confer a less favorable prognosis. Consideriamo, in questo articolo gli ITP, una categoria di docenti che può accedere all’insegnamento soltanto con il diploma di scuola secondaria superiore, molti dei quali sono nella III fascia delle graduatorie di Istituto. Con ordinanza cautelare, il TAR Lazio ha accolto il ricorso proposto dallo Studio Legale Marone disponendo l’inserimento dei docenti con Diploma ITP nelle Graduatorie ad Esaurimento. E a quale GPS? Miur, Consiglio di Stato e Tar del Lazio La vicenda dei diplomati magistrali agita ancora gli animi, e solo pochi giorni fa si è arrivati a … Testing for HIV or hepatitis C infection (or both) is indicated in at-risk populations and the latter may occur more widely than previously appreciated.12  Remissions induced by eradication of asymptomatic Haemophilus pylori infection have been reported in studies from Italy and Japan,13,14  but is not our experience.15  We neither perform the more sensitive breath testing nor treat empirically at presentation, but consider testing in chronic cases and those with gastrointestinal symptoms. Such preferences must be respected. 6,7 Two recent publications have questioned this perception. Per Aderire al Ricorso al Tar del Lazio per i Diplomati ITP in GAE scarica e spedisci la modulistica. A complete or partial remission occurs in 25% to 50% of patients; many complete responses are durable (> 1 year).60,61  Side effects are mostly related to the first infusion (fever, chills, hypotension, bronchospasm, etc). Emilia G, Longo G, Luppi M, et al. Schwartz J, Eldor A, Gillis S, Guinta A, Leber M, Bussel JB. McMillan R, Wang L, Tani P. Prospective evaluation of the immunobead assay for the diagnosis of adult chronic immune thrombocytopenic purpura (ITP). Profound and prolonged peripheral B-cell depletion is universal, but serious infection other than reactivation of hepatitis B in chronic carriers is rare and generally seen only in the context of additional immunosuppression. N400/2017 *** Dopo la recente e storica vittoria presso il Tribunale del Lavoro, che ha inserito nelle GAE i docenti abilitati ITP vengono riaperti i termini … Urgent treatment is initiated with intravenous methylprednisolone (1.0 g/d for 1-3 consecutive days) combined with IVIG (Figure 1). Docenti ITP in seconda fascia dopo sentenze negative. McMillan R, Durette C. Long-term outcomes in adults with chronic ITP after splenectomy failure. Search for other works by this author on: George JN, Vesely SK. e/o in GAE sono numerosi, in tanti hanno fatto anche ricorso per partecipare al concorso per docenti abilitati 2018 e in alcuni casi il Consiglio di Stato si è espresso favorevolmente ammettendoli con riserva . Kojouri K, Vesely SK, Terrell DR, George JN. Recommendations of the Advisory Committee on Immunization Practices (ACIP): use of vaccines and immune globulins in persons with altered immunocompetence. Newman GC, Novoa MV, Fodero EM, Lesser ML, Woloski BMR, Bussel JB. Scuola, docenti ITP: è un momento particolare questo, per gli insegnanti tecnico pratici (ITP). Sono . A sancirlo sono state le storiche pronunce giudiziarie 9234/17, 6443/17 e 4879/18 del Tar Lazio, che contro ogni pronostico ha ufficialmente riconosciuto il Diritto dei Diplomati ITP ad entrare in GAE. I Diplomati ITP devono essere Inseriti in GAE. Gli ITP inseriti tramite ricorso, che fine faranno? Solo pochi giorni fa si è avuto il pronunciamento del Tar del Lazio sulla questione degli ITP in seconda fascia: ecco cosa è stato deciso. Stasi R, Pagano A, Stipa E, Amadori S. Rituximab chimeric anti-CD20 monoclonal antibody treatment for adults with chronic idiopathic thrombocytopenic purpura. avviso per i lettori. Comparison of platelet counts in first and second newborns of mothers with immune thrombocytopenic purpura. I tempi sono ormai maturi al fine di permettere a migliaia di aspiranti docenti di poter far valere i propri diritti. Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications. What about the high school student able to afford college only if awarded a football scholarship, the policeman who routinely faces physical confrontation, the 28 year-old hard-hat construction worker, the 19-year-old woman with marked menorrhagia unresponsive to hormonal management, the 26-year-old who feels completely drained of energy unless her platelet count approaches 50 000 × 109/L, or even the extensive traveler. George JN. Stessa sorte per gli ITP e altre categorie di docenti.Sono ormai centinaia i rigetti dei tribunali per l’inserimento in GAE , ma nonostante ciò si continuano a proporre ricorsi senza senso , solo per spillare soldi ai propri associati. A new approach is the use of thrombopoietic factors. Ricorso: ITP in GaE – Sentenza del Consiglio di Stato. High P-glycoprotein-mediated export observed in patients with a history of idiopathic thrombocytopenic purpura. Scaradavou A, Woo B, Woloski BMR, et al. Approximately 85% of patients attain a hemostatic response after splenectomy and two thirds achieve a durable response (for reviews, see Kojouri et al48  and Schwartz et al49 ). Optimal dosing for ITP and use in combination with other modalities is under investigation. Kuter D, Bussel JB, Aledort LM, et al. Gaines AR. Il punteggio sarà dato dai titoli dichiarati dagli aspiranti. Ideally, maternal platelet counts should be maintained above 20 000 × 109/L throughout pregnancy and above 50 000 × 109/L near term to minimize the need for platelet transfusions in the event an emergency cesarean section is required,2,3,79  but a higher platelet count may be required for epidural anesthesia. DiFino SM, Lachant NA, Kirshner JJ, Gottlieb AJ. Initial treatment of immune thrombocytopenic purpura with high-dose dexamethasone. Figure 1 shows our treatment algorithm for initial management. Samuelsson A, Towers TL, Ravetch JV. I Diplomati ITP devono essere Inseriti in GAE. von dem Borne AEGK, Vos JJE, Pegels JG, Thomas LLM, van der Lelie H. High dose intravenous methylprednisolone or high dose intravenous gammaglobulin for autoimmune thrombocytopenia. Nomura S, Kazuo D, Tomomitsu H, Fujimura K, Ikeda Y. Le GaE sono in via di pubblicazione, mentre la seconda fascia delle GI sarà pubblicata a settembre. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. In the event of relapse, the long-term risks (eg, secondary malignancy, MDS) must be weighed against the potential benefits of resuming therapy. Mycophenolate mofetil (MMF) for the treatment of steroid-resistant idiopathic thrombocytopenic purpura. The largest reported experience involves 14 patients with refractory ITP who were more than 6 months after transplantation at the time of publication.74  Of these, 6 attained stable platelet counts that were greater than 100 000 × 109/L and 2 had partial responses (follow-up 9-42 months). (1) The goal of therapy in this population is to maintain a hemostatic platelet count while minimizing drug-induced toxicity; select patients may require somewhat higher platelet counts because of comorbid risk factors as discussed in “Treatment of chronic ITP.” (2) Our preference is to use anti-CD20 if not used previously and we consider reuse if a response was seen prior to splenectomy. Michel M, Novoa MV, Bussel JB. Una nota del Miur inviata ai Dirigenti Scolastici, di Prato e Pistoia, chiarisce che p otrà permanere con riserva solo chi ha già ricevuto un provvedimento giurisdizionale favorevole . ITP in Gae o II fascia GI. Diploma ITP in GAE! Until recently, experience from numerous centers over more than a half-century indicated that the typical adult with ITP is a woman, generally between 18 and 40 years of age.6  Gender disparity largely disappears among the elderly.6,7  Two recent publications have questioned this perception. Docenti ricorso inserimento in GaE: possibile e consigliato iscriversi alle graduatorie provinciali GPS. Portiejle JEA, Westendorp RGJ, Kluin-Nelemans HC, Brand A. Morbidity and mortality in adults with idiopathic thrombocytopenic purpura. Initial management of immune thrombocytopenic purpura in adults: a randomized controlled trial comparing intermittent anti-D with routine care. Doan CA, Bouroncle BA, Wiseman BK. George JN, Woolf SH, Raskob GE, et al. Pubblicato il 30/09/2019 30/09/2019 Pubblicato il ARTICOLI, News. ITP: Quali sono i diplomi e le classi di concorso dell’insegnante tecnico pratico30 Settembre 2019 Concorso ITP 2020: bando, come partecipare, prove, cosa studiare29 Aprile 2020 Come diventare ITP: mansioni, requisiti, diplomi, classi di concorso e stipendio18 Novembre 2019 Vianelli N, Valdre L, Fiacchini M, et al. Diploma ITP in GAE! The major decision is whether to temporize with medical therapy or to proceed swiftly to splenectomy. 6 Gender disparity largely disappears among the elderly. Sep 29 2020 Ricorso-Inserimento-In-Gae-2017-Diploma-Anief-Org 2/3 PDF Drive - Search and download PDF files for free. Con ordinanza cautelare, il TAR Lazio ha accolto il ricorso proposto dallo Studio Legale Marone disponendo l'inserimento dei docenti con Diploma ITP nelle Graduatorie ad Esaurimento. There is no consensus concerning the optimal duration of corticosteroid treatment. Reiner A, Gernsheimer T, Schlichter SJ. In questo articolo ti parliamo di una figura poco conosciuta del mondo della scuola, il docente ITP: si tratta dell’Insegnante Tecnico Pratico. Bruno Ventura - 4 Settembre 2019. Does treatment with intermittent infusions of IV anti-D allow a proportion of adults with recently diagnosed immune thrombocytopenic purpura (ITP) to avoid splenectomy? Burrows RF, Kelton JG. itp itp . Le tesi sostenute dal Sindacato Asset Scuola hanno centrato ancora una volta nel segno. Di. I Diplomati ITP devono essere Inseriti in GAE, a sancirlo sono state le storiche pronunce giudiziarie 9234/17 e 6443/17 del Tar Lazio. Nessuno sarà mai inserito in GAE né in II fascia. Although splenectomy has been performed safely at exceedingly low platelet counts, nonresponders may experience bleeding problems after the procedure. Diplomati ITP in GAE: pronuncia Storica del Tribunale di Torino #AssetScuola Brighton TA, Evans S, Castaldi PA, Chesterman CN, Chong BH. We treat patients with persistent ITP with the goal of maintaining the platelet count more than 20 000 to 30 000 × 109/L while avoiding steroid-induced osteoporosis, cataracts, and other toxicities. Effects of pegylated recombinant human megakaryocyte growth and development factor in patients with idiopathic thrombocytopenic purpura. Cines DB, Blanchette V. Idiopathic thrombocytopenic purpura. Patients should drink at least 2 L liquids daily to prevent hemorrhagic cystitis, and the blood count should be monitored weekly. Prospective screening of 205 patients with ITP, including diagnosis, serological markers, and the relationship between platelet counts, endogenous thrombopoietin, and circulating anti-thrombopoietin antibodies. Najean Y, Rain J-D, Billotey C. The site of destruction of autologous 111In-labelled platelets and the efficiency of splenectomy in children and adults with idiopathic thrombocytopenic purpura: a study of 568 patients with 268 splenectomies. Per quanti di loro hanno intrapreso le vie giudiziali per entrare in II fascia e nelle GAE si prospettano nuovi sviluppi sulla base di alcune pronunce del TAR. ITP requisiti di accesso GPS Non sono un legale, ma non mi è parso di capire in queste "storiche pronunce giudiziare" che gli ITP abbiano diritto ad essere inseriti in GAE. Intravenous anti-D treatment of immune thrombocytopenic purpura: experience in 272 patients. Management of asplenic patients. Our usual practice is to maintain a somewhat higher platelet count initially (eg, 30 000 × 109/L) while we get to know the patient, with the goal of establishing a track record of bleeding, compliance, and risk management that allows us to modify the threshold for treatment over time. There were no procedural deaths, but sepsis was common and 2 of the 6 complete responders died within a year. ricorso per ottenere equiparazione stipendiale docenti sostegno ii grado diplomati. COMPILA IL FORM CON I TUOI DATI. Supplenze; Supplenze scuola 2020/21 e graduatorie provinciali: indicazioni per ITP e docenti inseriti in Gae. Si tratta di un vero e proprio trionfo per l’i The first was a survey from a single county in Denmark using International Classification of Disease (ICD) codes at hospital discharge over a 22-year period. The long-term effect of treatment on immune surveillance is unknown. The female-male ratio was 1.7, the median age at diagnosis was 56 years, and the incidence of ITP increased with age and increased overall during the period of study.8  The second was a prospective cohort analysis of newly presenting adults with platelet counts less than 50 000 × 109/L in the Northern Health Region of the United Kingdom. All febrile illnesses demand careful evaluation and intravenous antibiotics should be provided urgently at the onset of any systemic illness with fever of 38°C (101°F) or higher until bacterial sepsis can be excluded. Marked discrepancies between the neonatal and maternal platelet count are not uncommon. McMillan R. Therapy for adults with refractory chronic immune thrombocytopenic purpura. All others can be treated as outpatients. Entriamo nel dettaglio. Helicobacter pylori eradication can induce platelet recovery in idiopathic thrombocytopenic purpura. A phase 2 placebo controlled study evaluating the platelet response and safety of weekly dosing with a novel thrombopoietic protein (AMG531) in thrombocytopenic adult patients (pts) with immune thrombocytopenic purpura (ITP) [abstract]. Un’altro ostacolo, questa volta riguarda gli ITP che chiedevano l’ingresso in GaE? The bleeding risk and natural history of idiopathic thrombocytopenic purpura in patients with persistent low platelet counts. The initial goal of treatment is to attain a hemostatic platelet count (≥ 30 000 × 109/L) while minimizing the toxicity of treatment. POSTI DISPONIBILI SUL SOSTEGNO: SCARICA LA TABELLA, CONCORSO DOCENTI 2020: ABILITAZIONE PER CHI PARTECIPA, RIVOLUZIONE SUPPLENZE DOCENTI: COME ENTRARE NEGLI ELENCHI PROVINCIALI, STABILIZZAZIONE DOCENTI: COME ADERIRE AL RICORSO GRATUITO, BONUS DOCENTI PER I PRECARI: COME ADERIRE, MOBILITA’ DOCENTI E ATA: COME OTTENERE IL TRASFERIMENTO, FDP 8 MODULI: LA NUOVA CERTIFICAZIONE PER DOCENTI E ATA. There is limited experience with chemotherapy for neoplastic diseases in pregnant women that may be helpful in managing the truly exceptional case (for reviews, see Koren et al84  and Weisz et al85 ). Prospective evaluation of usefulness of an antigen-specific assay (MAIPA) in idiopathic thrombocytopenic purpura and other immune thrombocytopenia. Idiopathic thrombocytopenic purpura in adults: current issues for pathogenesis, diagnosis and management. Bourgeois E, Caulier MT, Delarozee C, Brouillard M, Bauters F, Fenaux P. Long-term follow-up of chronic autoimmune thrombocytopenic purpura refractory to splenectomy: a prospective analysis. Most of the time the bleeding is contained underneath the skin and appears as a bruise, so you might dismiss the symptoms as something else. Michel M, Cooper N, Jean C, Frissora C, Bussel JB. We hospitalize (1) patients with profound mucocutaneous or internal bleeding and (2) those who present with platelet counts of less than 20 000 × 109/L and a history of significant bleeding, those in whom there is a question about compliance, and in some cases, those in whom responsiveness to therapy has not been established—for example, when comorbid factors predisposing to bleeding or complications of therapy are present. How can we provide the best care for our patients with immune thrombocytopenic purpura? Azathioprine (Imuran) and pregnancy. Calverley DC, Jones GW, Kelton JG. Our preference is to use azathioprine (2 mg/kg orally every day adjusted to avoid severe neutropenia), preferably in combination with danazol (10-15 mg/kg/d), typically 600-800 mg per day, as the first approach to chronic immunosuppression because the incidence of acute and serious side effects is lower than with cyclophosphamide and the frequency of lasting remissions is comparable (20%-40%).58  However, responses occur more slowly (typically 3-4 months) and this agent, like danazol, is often stopped prematurely. Con questa clamorosa decisione il Tribunale di Torino ha disposto un nuovo cambio di rotta rispetto all’inserimento in GAE dei Diplomati ITP. Cooper N, Heddle NM, Haas M, et al. po indicates orally; prn, as needed; and q, every. Gli ITP vanno considerati come dei docenti a tutti gli effetti, al pari degli insegnanti laureati, e sono riconosciuti giuridicamente ed economicamente docenti sulla base del DLgs 1277/48 pubblicato sulla GU 6/11/1948 n.259. Osservatorio Docenti e il responsabile legale, Avv.Giuseppe Buonanno, hanno conseguito un ulteriore importantissima vittoria innanzi al Tar Lazio Roma che sarà utile a consentire agli appartenenti alla categoria ITP di essere inseriti nelle GAE o Graduatorie d’Istituto nella classe (dichiarata ad esaurimento) A066 (o in quelle immediatamente compatibili). Thrombocytopenia recurs in most patients when corticosteroids are tapered. Stasi R, Stipa E, Masi M, et al. Questa la frase utilizzata sul sito: "A sancirlo sono state le storiche pronunce giudiziarie 9234/17, 6443/17 e 4879/18 del Tar Lazio, che contro ogni pronostico ha ufficialmente riconosciuto il Diritto dei Diplomati ITP ad entrare in GAE." However, long-term effects of the procedure on the incidence of occlusive cerebrovascular disease remain under study. Spontaneous or posttraumatic ICH or bleeding at other internal sites is uncommon, but not without precedence,24  at platelet counts between 10 000 and 20 000 × 109/L. Some experts would apply this reasoning to recommendations for splenectomy,28  although we use a higher threshold (see “Splenectomy”). Causale: Codice fiscale + Ricorso Depennati Gae + nome e cognome del ricorrente. Come è noto a molti, il reclutamento dei docenti avviene tramite un sistema basato su elenchi di nomi di candiati ordinati in base al proprio punteggio: le graduatorie. Mortality rates for open and laparoscopic splenectomy are 1.0% and 0.2%, respectively.48  The outcomes of the 2 approaches are comparable,53  although the former hastens recovery and offers better cosmesis. Levy AS, Cunningham-Rundles S, Mazza B, Simm M, Gorlick R, Bussel J. The risk of ICH is estimated to be less than 1%, which we think is less than that of percutaneous umbilical vein sampling in severely thrombocytopenic fetuses.3,76  We are not aware of evidence that the risk of ICH can be reduced by cesarean section.89  We measure cord platelet counts in all newborns and serial platelet counts should be obtained during the first week postpartum because the onset of severe thrombocytopenia may be delayed. Blood 2005; 106 (7): 2244–2251. 59/2017). There is room for disagreement in each of these cases, but they illustrate the types of issues confronted in real practice. Before splenectomy in Rh+ patients, we have combined IVIG and IV anti-D, which act through different IgG-Fcγ receptors,34-36,63  with vincristine and methylprednisolone,37  and platelet transfusions (bolus followed by continuous infusion as needed) for life- or organ-threatening bleeding or after head trauma.38  Recombinant factor VIIa may be added in patients unresponsive to other modalities if an immediate response is necessary, such as with ICH.39  IVIG is generally well tolerated other than for a postinfusion headache. An alternative is to use cyclophosphamide either intravenously (2 or 3 courses of 500-1000 mg/m2 at 3-4-week intervals)67  or orally (1-2 mg/kg daily adjusted to avoid severe neutropenia). We treat most patients with prednisone (1.0 mg/kg/day) orally as the initial approach. For patients who do not respond to rituximab, we generally initiate therapy with at least 2 agents to avoid inducing multiple drug resistance genes.62  This approach also permits the more problematic agent to be tapered first. ITP con ricorso inseriti in seconda fascia o in GAE, chi può partecipare al concorso docenti 2018. Treatment must be continued for 4 to 6 months to see its full effect. Cyclosporin A for the treatment of patients with chronic idiopathic thrombocytopenia purpura refractory to corticosteroids or splenectomy. IV anti-D and platelet transfusions may be given as needed; repeated or continuous platelet transfusions may be required in urgent situations; all 3 modalities given prior to transfusions may help preserve their longevity in the circulation. This trend has been accelerated by evidence that IV anti-D and anti-CD20 may allow splenectomy to be deferred and possibly avoided.41,47, We use IVIG, IV anti-D, or pulse doses of corticosteroids in known responders to boost the platelet count prior to splenectomy. Our opinion is that it is as unreasonable to apply a “one-size fits all” threshold as it would be to attempt to normalize platelet counts in all patients. Pulse cyclophosphamide therapy for refractory autoimmune thrombocytopenic purpura. Splenic radiation for corticosteroid-resistant immune thrombocytopenia. Nation-wide study of idiopathic thrombocytopenic purpura in pregnant women and the clinical influence on neonates. Combination chemotherapy in refractory immune thrombocytopenic purpura. Il Ministero dell’Istruzione con Decreto Ministeriale del 24 aprile 2019, n. 374 (doc. Solo pochi giorni fa si è avuto il pronunciamento del Tar del Lazio sulla questione degli ITP in seconda fascia: ecco cosa è stato deciso. Si tratta di un vero e … However, it is also important to point out that precipitous falls are seen on occasion and demand more intensive therapy with its attendant complications. Is the platelet count a reasonable surrogate marker for the risk of serious bleeding? Navigazione articoli. We have recently found IV anti-D to be safe (including for the newborn) and effective, although experience is limited, caution is indicated, and close monitoring of the fetus with sonograms and the newborn with hemoglobin and bilirubin determinations is warranted.81  Splenectomy should be avoided if possible, and deferred to the second trimester when necessary, to avoid abortion. den Ottolander GJ, Gratama JW, de Koning J, Brand A. Diventare ITP - Come iscriversi nelle Graduatorie di Istituto. ricorso per ottenere equiparazione stipendiale docenti sostegno ii grado diplomati. IVIg-mediated amelioration of murine ITP via FcγRIIB is independent of SHIP1, SHP-1, and Btk activity. Song S, Crow AR, Siragam V, Freedman J, Lazarus AH. Many of the symptoms of immune thrombocytopenia (ITP), previously known as idiopathic thrombocytopenia, stem from a low platelet count leading to excessive bleeding. Options are limited, alternative therapies are toxic, the minority of patients respond, and morbidity and mortality are considerable, approaching 10% to 15% in some series.24-26  We generally reserve the treatments we describe for patients who are clearly refractory to previously mentioned modalities (ie, splenectomy, danazol, rituximab, or immunosuppressants) and who have had serious morbidity or have extremely low platelet counts (eg, less than 10 000 × 109/L). In the largest series to date, 25% to 30% of patients showed responses lasting longer than 1 year.47  Alternatives, including anti-CD20 (rituximab) or danazol are discussed (see “First-line therapy” and “Second-line therapy,” respectively). Leung AYH, Chim CS, Kwong YL, Lie AKW, Au WY, Liang R. Clinicopathologic and prognostic features chronic idiopathic thrombocytopenic purpura in adult Chinese patients: an analysis of 220 cases. We do not use danazol, cyclophosphamide, anti-CD20, vinca alkaloids, and other potentially teratogenic therapy (with the possible exception of azathioprine for which a registry exists for renal transplant recipients83 ). We generally use corticosteroids as initial therapy, but this can induce or exacerbate gestational diabetes, bone loss, hypertension, and perhaps abruption and prematurity.80  For this reason, we tend to rely more on IVIG together with low-dose prednisone (20 mg every day) than in nonparous patients. We have less personal experience with the use of mycophenolate mofetil.63,64  Treatment is begun with 500 mg orally twice a day and the dose is increased to 1000 to 1500 mg orally twice a day after 2 weeks. The reader is referred elsewhere for a more comprehensive tabulation of drug doses, expected response times, and common side effects.30  Therapy is indicated in all patients who present with bleeding and those with platelet counts less than 20 000 × 109/L because fewer than 10% of adults rapidly attain spontaneous remission. I ricorsi per essere inseriti in II fascia G.I. che, invece, per quanto riguarda i docenti ITP che hanno conseguito il titolo prima della chiusura delle GAE il ricorso – prescindendosi dai profili di inammissibilità del ricorso per non avere i ricorrenti tempestivamente impugnato il D.M. The female-male ratio was 1.2 and, again, the age-specific incidence was highest among those older than 60 years.9  Presenting symptoms, severity of thrombocytopenia, and response to therapy were typical for ITP, so these data do not simply reflect increased detection of mild cases based on automated platelet determinations,10  misdiagnosed myelodysplasia (MDS),11  or drug-dependent antibodies.