Suggested Algorithm for the Management of Immune Thrombocytopenia in Systemic Lupus Erythematosus (SLE) - Flowchart
Suggested Algorithm for the Management of Immune Thrombocytopenia in Systemic Lupus Erythematosus (SLE) - Flowchart Systemic Lupus Erythematosus Systemic Lupus Erythematosus
«Flowchart»

Thrombocytopenia requiring treatment
(Active bleeding or PLTs < 20-30,000/mm3)

Thrombocytopenia requiring treatment
(Active bleeding or PLTs < 20-30,000/mm3)

Thrombocytopenia requiring treatment
(Active bleeding or PLTs < 20-30,000/mm3)

Thrombocytopenia requiring treatment
3

Immediate treatment

High-dose GC
Consider IV MP pulses, followed by Pre 0.5-0.6 mg/kg/day for 3-4 wk, then taper

Immediate treatment

Immediate treatment

High-dose GC
Consider IV MP pulses, followed by Pre 0.5-0.6 mg/kg/day for 3-4 wk, then taper

High-dose GC
Consider IV MP pulses, followed by Pre 0.5-0.6 mg/kg/day for 3-4 wk, then taper Immediate treatment

IVIG
Consider if active bleeding, contraindications to GC or more rapid increase in PLTs required

IVIG
Consider if active bleeding, contraindications to GC or more rapid increase in PLTs required

IVIG
Consider if active bleeding, contraindications to GC or more rapid increase in PLTs required IVIG

With or without

With or without

With or without

With or without

Chronic treatment

Add IS drug (AZA or MMF or CsA) Slow taper of GC

Chronic treatment

Add IS drug (AZA or MMF or CsA) Slow taper of GC

Chronic treatment

Chronic treatment

Add IS drug (AZA or MMF or CsA) Slow taper of GC

Add IS drug (AZA or MMF or CsA) Slow taper of GC

Relapse?

Relapse?

Relapse?

Relapse?

2nd line treatment
RTX, or high-dose IV CYC

2nd line treatment
RTX, or high-dose IV CYC

2nd line treatment
RTX, or high-dose IV CYC

2nd line treatment
RTX, or high-dose IV CYC

End

End

End

3nd line treatment
TPO-agonists Splenectomy

3nd line treatment
TPO-agonists Splenectomy

3nd line treatment
TPO-agonists Splenectomy

3nd line treatment
TPO-agonists Splenectomy

Target reached
(PLTs >50,000/mm3)

Target reached
(PLTs >50,000/mm3)

Target reached
(PLTs >50,000/mm3)

Target reached
3

Yes

Yes

Yes Yes

No

No

No No

Target reached
(PLTs > 50,000/mm3)

Target reached
(PLTs > 50,000/mm3)

Target reached
(PLTs > 50,000/mm3)

Target reached
3

Yes

Yes

Yes Yes

No

No

No No