PB1347 - Evaluating local practice patterns and IVIg use to treat immune thrombocytopenia.

Tuesday, June 27, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Chad Kimmitt, MD (he/him/his)

Resident
University of Calgary, Cumming School of Medicine, Department of Medicine
CALGARY, Alberta, Canada

Co-Author(s)

JS

Jennifer Smiechowski

Resident
University of Calgary, Cumming School of Medicine, Department of Medicine
Calgary, Alberta, Canada
FM

Farheen Manji

Resident
Division of Hematology & Hematological Malignancies, Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada.
Calgary, Alberta, Canada
DG

Dawn Goodyear

Clinical Associate Professor
Division of Hematology and Hematological Malignancies, Department of Medicine, University of Calgary, AB, Canada
Calgary, Alberta, Canada
NR

Natalia Rydz

Clinical Associate Professor
Division of Hematology and Hematological Malignancies, Department of Medicine, University of Calgary, Calgary, AB, Canada
Calgary, Alberta, Canada
DS

Davinder Sidhu

Physician
Department of Pathology and Laboratory Medicine, University of Calgary
Calgary, Alberta, Canada
AL

Adrienne Lee

Physician
Division of Hematology & Hematological Malignancies, Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada.
Calgary, Alberta, Canada
Leslie Skeith, MD

Associate Professor
Division of Hematology and Hematological Malignancies, Department of Medicine, University of Calgary, Calgary, AB, Canada
Calgary, Alberta, Canada

Background: Immune thrombocytopenia (ITP) is a disorder characterized by immune-mediated platelet destruction and impaired platelet production that can be treated with intravenous immunoglobin (IVIg). By understanding the use of IVIg in ITP, we can identify gaps to develop a regional best practice guideline or educational initiatives to optimize use.

Aims: (1) Evaluate practice patterns of IVIg use among physicians treating ITP locally, and (2) Evaluate the appropriateness of use according to IWG guidelines.

Methods: We performed a retrospective data analysis using Alberta Health Services Provincial Laboratory Services; dynaLife; Sunrise Clinical Manager, and Transfusion Medicine records, which was supplemented by patient chart review. Inclusion criteria were patients 18 years of age and older diagnosed with ITP based on ICD-10 codes between 2012-2017 in Calgary and who received IVIg. We assessed the responsiveness, and appropriateness by indication according to the IWG guidelines (Ethics approval REB18-1798).

Results: There were 158 patients included who were diagnosed with ITP and received IVIg (Table 1). There were 80.1% of patients who achieved an early response with IVIg therapy and 58.2% of patients who achieved a complete remission. The mean number of days until repeat IVIg therapy was 60.4 days. The use of IVIg in managing ITP was appropriate in 67.6% of cases. Indications for IVIg use for ITP varied, with bleeding being the most common indication followed by need for rapid platelet increase and then physician preference.

Conclusion(s): There is variation in prescribing practices of IVIg for ITP, and some product use does not align with IWG guidelines. This identifies a gap that may be targeted with a local order set, educational initiative or a regional practice guideline.