Thrombocytopenia may worsen initially. 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. 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. Cooper N, Stasi R, Cunningham-Randles S, et al. Diplomati ITP in GAE: pronuncia Storica del Tribunale di Torino #AssetScuola Vianelli N, Valdre L, Fiacchini M, et al. Disseminated intravascular coagulation associated with acute hemoglobinemia or hemoglobinuria following Rh0 (D) immune globulin intravenous administration for immune thrombocytopenic purpura. Le tesi sostenute dal Sindacato Asset Scuola hanno centrato ancora una volta nel segno. 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. High P-glycoprotein-mediated export observed in patients with a history of idiopathic thrombocytopenic purpura. Docenti ITP in seconda fascia dopo sentenze negative. How can we provide the best care for our patients with immune thrombocytopenic purpura? Response rates vary from 50% to 90% depending on intensity and duration of therapy, but only 10% to 30% of patients enter stable remission once therapy is tapered or stopped1,7,25,41,43-46 ; even those who enter remission often require additional or alternative therapy, at least initially.47  We taper prednisone slowly, especially once doses of 10 mg/d are reached, to avoid adrenal insufficiency. 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. Common toxicities of IV anti-D include fever/chill reactions, which can be ameliorated by pretreatment with corticosteroids, and extravascular hemolysis; intravascular hemolysis and disseminated intravascular coordination are rare33,91  and the risk is lessened by avoiding treatment in those with a positive direct antiglobulin test unless attributable to prior IVIG or IV anti-D therapy. Godeau B, Chevret S, Varet B, et al. Although few otherwise healthy, sedentary individuals die of hemorrhage over a 10-year period if they maintain a stable platelet count more than 20 000 × 109/L and though we rarely treat patients with platelet counts more than 30 000 × 109/L in the absence of extenuating circumstances that predispose to serious bleeding, no published follow-up is of sufficient length or size to project risk over a life span. We have used aspirin in patients at risk for thrombosis (even in the absence of antiphospholipid antibody) whose platelet counts increase rapidly to more than 600 000 × 109/L.16. Long-term follow-up study of 168 patients with immune thrombocytopenic purpura. Although rare, major bleeding has been reported at platelet counts between 20 000 and 30 000 × 109/L. Michel M, Cooper N, Jean C, Frissora C, Bussel JB. Gaines AR. Graduatorie provinciali 2020: disposizioni per docenti inseriti nelle graduatorie ad esaurimento e per gli Insegnanti Tecnico Pratici. Dapsone for chronic autoimmune thrombocytopenic purpura: a report of 66 cases. Ne deriva, di conseguenza, che la vicenda dei docenti ITP ai fini dell’inserimento nelle GAE, è ancora aperta e tale sentenza potrà costituire un importante precedente. Nessuno sarà mai inserito in GAE né in II fascia. Diplomati ITP in GAE: Cosa Fare 15 Maggio 2019 Proroga Domande GAE al 20 Maggio: Nota Miur 14 Maggio 2019 Graduatorie GAE: i Ricorrenti possono chiedere l’Inserimento con Riserva 14 Maggio 2019 Aggiornamento GAE: da Settembre le prime Convocazioni 10 Maggio 2019 In our limited experience, patients who responded but had a relapse often respond to subsequent courses. di seconda fascia – gdl; ricorso ii fascia – itp – laureati; ricorso mobilità 2019; ricorso concorso docenti 2018 – fase transitoria; ricorso tfa sostegno 2018 itc – laureati no 24cfu Baumann MA, Menitove JE, Aster RH, Anderson T. Urgent treatment of idiopathic thrombocytopenic purpura with single-dose gammaglobulin infusion followed by platelet transfusion. Fujimura K, Harada Y, Fujimoto T, et al. Sono un ITP con ricorso per l’inserimento in GaE in attesa di risposta; posso iscrivermi? Howard J, Hoffbrand AV, Prentice HG, Mehta A. Mycophenolate mofetil for the treatment of refractory auto-immune haemolytic anemia and auto-immune thrombocytopenia purpura. These assays lack sufficient sensitivity to exclude a diagnosis of ITP18-20  and interlaboratory reproducibility is inadequate.21. Pregnancy in patients with idiopathic thrombocytopenic purpura: assessing the risks for the infant at delivery. If a complete response occurs to oral therapy, we give full doses for an additional 3 months and then strongly consider stopping treatment. 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. 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. 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). Various combinations of chemotherapeutic agents have been used successfully in small numbers of heavily pretreated patients.69  In one study, the long-term outcome of 12 patients (follow-up 35-150 months) included 5 complete and 1 partial remission.70  Therapy should be stopped if there is no response after 2 courses and the literature is based on treating responders with at least 3 or more courses even if the platelet count has normalized. However, we often use these agents initially because the other suggested treatments typically require weeks to months for their effect to become apparent. Disturbances in thyroid function occur with sufficient frequency that we often measure thyroid-stimulating hormone levels if there are complaints of persistent fatigue and prior to splenectomy. Una nota del Miur inviata ai Dirigenti Scolastici, di Prato e Pistoia, chiarisce che potrà permanere con riserva solo chi ha già ricevuto un provvedimento giurisdizionale favorevole. Ricorso per l’Inserimento in Gae dei Docenti ITP a: undisclosed-recipients:; 10/02/2017 20:30:47 Ricorso per l’Inserimento in Gae dei Docenti ITP Il Sindacato Asset Scuola non è rimasto sordo di. The initial goal of treatment is to attain a hemostatic platelet count (≥ 30 000 × 109/L) while minimizing the toxicity of treatment. Ricorso collettivo al Tar Lazio riservato ai docenti in possesso di diploma ITP finalizzato ad ottenere l’accesso nelle graduatorie ad esaurimento Effect of Helicobacter pylori eradication on platelet recovery in Japanese patients with chronic idiopathic thrombocytopenic purpura and secondary autoimmune thrombocytopenic purpura. Il punteggio sarà dato dai titoli dichiarati dagli aspiranti. If the patient does not wish to temporize, we recommend splenectomy within 3 to 6 months if any therapy (eg, more than 10 mg prednisone/d) is required to maintain a platelet count greater than 30 000 × 109/L. 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. Huhn RD, Fogarty PF, Nakamura R, et al. Although some argue that current methods to detect platelet antigen-specific antibodies are now sufficiently specific to affirm the diagnosis, antibodies have also been detected in 10% to 20% of patients with certain causes of “nonimmune” thrombocytopenias (eg, chronic liver disease, MDS), the populations in which testing would be most helpful. Helicobacter pylori eradication can induce platelet recovery in idiopathic thrombocytopenic purpura. McCrae KR, Samuels P, Schreiber AD. 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. Management of adult patients with persistent idiopathic thrombocytopenic purpura following splenectomy. 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. Our practice is to continue full doses for 3 to 4 weeks, until a response is seen or side effects become intolerable. Women with ITP may consult their physician as to the safety of becoming pregnant or the diagnosis may be considered for the first time during pregnancy because years may have passed since a complete blood count was performed. RICORSO INSERIMENTO GAE DOCENTI ITP - ITC IMPUGNAZIONE GRADUATORIE AD ESAURIMENTO DI CUI AL DECRETO MINISTERIALE. (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. 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. Payne SD, Resnik R, Moore TR, Hedriana HL, Kelly TF. 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. Recommendations of the Advisory Committee on Immunization Practices (ACIP): use of vaccines and immune globulins in persons with altered immunocompetence. Alkylating agents should be avoided or minimized (total dose of cyclophosphamide < 2000 mg/m2) in younger adults and those wishing to have children, whereas other medications may adversely affect comorbid conditions (eg, corticosteroids and bone density or danazol and prostate disease). Inserire nel plico la copia del bonifico effettuato. The long-term effect of treatment on immune surveillance is unknown. Shehata N, Burrows R, Kelton JG. Is the platelet count a reasonable surrogate marker for the risk of serious bleeding? Does Helicobacter pylori initiate or perpetuate immune thrombocytopenic purpura? Prospective screening of 205 patients with ITP, including diagnosis, serological markers, and the relationship between platelet counts, endogenous thrombopoietin, and circulating anti-thrombopoietin antibodies. American Academy of Pediatrics Committee on Infectious Diseases. 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. Cohen YC, Djulbegovic B, Shamai-Lubovitz O, Mozes B. Il docente ITP protagonista del ricorso, era entrato nei ruoli scolastici nell’anno 2001 tramite il cosiddetto doppio canale, sulla classe C270 Laboratorio di Elettrotecnica, anche se il medesimo risultava inserito nelle graduatorie anche sulla classe C290 Laboratorio di Fisica. We use ϵ-aminocaproic acid or tranexamic acid swish and swallow to help control oral bleeding, topical thrombin, collagen, and fibrin glue to manage dental extractions, and progestational agents to manage menorrhagia. We treat symptomatic relapses or severe recurrent thrombocytopenia in the same way as at initial presentation, that is, with corticosteroids or IVIG or the emergent measures described (see “Hospitalization and emergency therapy”) depending on severity, with the exception that few patients who have undergone splenectomy respond well to IV anti-D.59  Although some patients who failed to respond to these measures on presentation do so after splenectomy, it is almost always wise to introduce additional medications, because few patients can be managed with chronic low-dose (5-10 mg) or alternate day doses of prednisone or wish to be bound indefinitely to parenteral therapy with IVIG. Contro ogni pronostico è stato affermato il diritto dei Diplomati ITP ad entrare in GAE. Fiduciosi delle recenti pronunce favorevoli ottenute, invitiamo coloro i quali non avessero ancora aderito a non perdere quest’ultima straordinaria occasione. ricorso per ottenere equiparazione stipendiale docenti sostegno ii grado diplomati. 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). Conversely, a poor response to treatment may necessitate re-evaluation of the diagnosis, including a bone marrow examination. 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. Diploma ITP in GAE! Le tesi sostenute dal Sindacato Asset Scuola hanno centrato ancora una volta nel segno. In questo articolo ti parliamo di una figura poco conosciuta del mondo della scuola, il docente ITP: si tratta dell’Insegnante Tecnico Pratico. I Diplomati ITP devono essere Inseriti in GAE. Policy statement: recommendations for the prevention of pneumococcal infections, including the use of pneumococcal conjugate vaccine (Prevnar), pneumococcal polysaccharide vaccine, and antibiotic prophylaxis (RE9960). ITP requisiti di accesso GPS Therapy of adult ITP following splenectomy. Alternatively, we combine danazol with either azathioprine or mycophenolate mofetil for a minimum of 4 months, if possible, and use corticosteroids or IVIG (or both) in the interim, as needed. McMillan R, Durette C. Long-term outcomes in adults with chronic ITP after splenectomy failure. Age as the major predictor of long-term response to splenectomy in immune thrombocytopenic purpura. McMillan R. Long-term outcomes after treatment for refractory immune thrombocytopenic purpura. Figure 1 shows our treatment algorithm for initial management. In the absence of symptoms or treatment, we monitor platelet counts at least monthly through the first 2 trimesters, biweekly in the third, weekly as term approaches and more often, if indicated. Letsky EA, Greaves M. Guidelines on the investigation and management of thrombocytopenia in pregnancy and neonatal alloimmune thrombocytopenia.