{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T22:37:57Z","timestamp":1792276677675,"version":"4.4.0"},"reference-count":95,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2016,4,7]],"date-time":"2016-04-07T00:00:00Z","timestamp":1459987200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Br J Haematol"],"published-print":{"date-parts":[[2016,6]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>With prolonged life expectancy, immune thrombocytopenia (<jats:styled-content style=\"fixed-case\">ITP<\/jats:styled-content>) is frequent in elderly people. In this setting, <jats:styled-content style=\"fixed-case\">ITP<\/jats:styled-content> diagnosis is challenging because of the concern about an underlying myelodysplastic syndrome. Studies of older adults are lacking, and recommendations for treatment are based mainly on expert opinion. The therapeutic strategy differs from that for younger patients and must take into account the greater risk of bleeding and thrombosis, presence of comorbidities, possible impaired cognitive performance or poor life expectancy and concomitant medications, such as anticoagulant and antiplatelet therapy. Steroids and intravenous immunoglobulin (<jats:styled-content style=\"fixed-case\">IVI<\/jats:styled-content>g) therapy remain the first\u2010line treatments in elderly patients, but prolonged treatment with steroids should be avoided and <jats:styled-content style=\"fixed-case\">IVI<\/jats:styled-content>g treatment may lead to renal failure. Splenectomy is less effective than in young patients and risk of thrombosis is increased. Severe co\u2010morbidities can also contraindicate surgery. Therefore, other second\u2010line treatments are frequently preferred. Danazol and dapsone can be an option for the less severe <jats:styled-content style=\"fixed-case\">ITP<\/jats:styled-content> form. Rituximab is a good option except in patients with a history of infection or with hypogammaglobulinaemia. Thrombopoietin agonists are attractive, especially for patients with severe comorbidities or with limited life expectancy but the risk of thrombosis is a concern.<\/jats:p>","DOI":"10.1111\/bjh.14067","type":"journal-article","created":{"date-parts":[[2016,4,10]],"date-time":"2016-04-10T17:49:58Z","timestamp":1460310598000},"page":"844-856","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["How we manage immune thrombocytopenia in the elderly"],"prefix":"10.1111","volume":"173","author":[{"given":"Matthieu","family":"Mah\u00e9vas","sequence":"first","affiliation":[{"name":"Service de M\u00e9decine Interne Centre de r\u00e9f\u00e9rence des cytop\u00e9nies auto\u2010immunes de l'adulte H\u00f4pital Henri Mondor Assistance Publique\u2010H\u00f4pitaux de Paris Universit\u00e9 Paris Est Cr\u00e9teil Cr\u00e9teil France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Michel","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Interne Centre de r\u00e9f\u00e9rence des cytop\u00e9nies auto\u2010immunes de l'adulte H\u00f4pital Henri Mondor Assistance Publique\u2010H\u00f4pitaux de Paris Universit\u00e9 Paris Est Cr\u00e9teil Cr\u00e9teil France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bertrand","family":"Godeau","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Interne Centre de r\u00e9f\u00e9rence des cytop\u00e9nies auto\u2010immunes de l'adulte H\u00f4pital Henri Mondor Assistance Publique\u2010H\u00f4pitaux de Paris Universit\u00e9 Paris Est Cr\u00e9teil Cr\u00e9teil France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,4,7]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1096\/fasebj.3.2.2914627","article-title":"Danazol therapy renders red cells resistant to osmotic lysis","volume":"3","author":"Ahn Y.S.","year":"1989","journal-title":"FASEB Journal"},{"key":"e_1_2_14_3_1","first-page":"157","article-title":"Intravenous immunoglobulin induced\u2010nephropathy: a complication of IVIG therapy","volume":"11","author":"Ahsan N.","year":"1998","journal-title":"Journal of Nephrology"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.2165\/00002512-200320110-00005"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-146-1-200701020-00006"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tmrv.2013.05.005"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2012.09169.x"},{"key":"e_1_2_14_8_1","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1182\/blood.V71.4.1165.1165","article-title":"Low doses v conventional doses of corticosteroids in immun thrombocytopenic purpura (ITP): results of a randomized clinical trial in 160 children, 223 adults","volume":"71","author":"Bellucci S.","year":"1988","journal-title":"Blood"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1053\/jinf.2001.0904"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0609.2005.00602.x"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2141.2003.04211.x"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2141.2003.04131.x"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.24011"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800831239"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lpm.2014.02.008"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2013.103291"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.2174\/157488607779315480"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa030254"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60959-2"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2015-03-631937"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra010501"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2004-12-4598"},{"key":"e_1_2_14_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.160.11.1630"},{"key":"e_1_2_14_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2004.04889.x"},{"key":"e_1_2_14_25_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V77.1.31.31"},{"key":"e_1_2_14_26_1","doi-asserted-by":"publisher","DOI":"10.1182\/asheducation-2010.1.385"},{"key":"e_1_2_14_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2007.07.006"},{"key":"e_1_2_14_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2796.2009.02126.x"},{"key":"e_1_2_14_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yjmcc.2015.01.021"},{"key":"e_1_2_14_30_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V94.3.909.415k02_909_913"},{"key":"e_1_2_14_31_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.285.22.2864"},{"key":"e_1_2_14_32_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V95.8.2523"},{"key":"e_1_2_14_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-011-1184-3"},{"key":"e_1_2_14_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.24102"},{"key":"e_1_2_14_35_1","doi-asserted-by":"publisher","DOI":"10.1182\/asheducation-2009.1.153"},{"key":"e_1_2_14_36_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2013.098921"},{"key":"e_1_2_14_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.28663"},{"key":"e_1_2_14_38_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200312043492318"},{"key":"e_1_2_14_39_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2141.1997.412687.x"},{"key":"e_1_2_14_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)07275-6"},{"key":"e_1_2_14_41_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2008-01-131029"},{"key":"e_1_2_14_42_1","doi-asserted-by":"publisher","DOI":"10.1111\/ejh.12146"},{"key":"e_1_2_14_43_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2012-09-455691"},{"key":"e_1_2_14_44_1","doi-asserted-by":"publisher","DOI":"10.1111\/ejh.12393"},{"key":"e_1_2_14_45_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.21512"},{"key":"e_1_2_14_46_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.1995.tb05179.x"},{"key":"e_1_2_14_47_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-03-274753"},{"key":"e_1_2_14_48_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-005-0125-6"},{"key":"e_1_2_14_49_1","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1182\/blood.V126.23.1691.1691","article-title":"Efficacy and safety of eltrombopag for treatment of patients with myelodysplastic syndromes after hypomethylating\u2010agent failure: a phase 2 clinical trial","volume":"126","author":"Khan M.","year":"2015","journal-title":"Blood"},{"key":"e_1_2_14_50_1","first-page":"829","article-title":"Assessment of a therapeutic strategy for adults with severe autoimmune thrombocytopenic purpura based on a bleeding score rather than platelet count","volume":"90","author":"Khellaf M.","year":"2005","journal-title":"Haematologica"},{"key":"e_1_2_14_51_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2014-06-582346"},{"key":"e_1_2_14_52_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2004-03-1168"},{"key":"e_1_2_14_53_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2015-08-667063"},{"key":"e_1_2_14_54_1","first-page":"1046","article-title":"Venous thromboembolism in very elderly patients: findings from a prospective registry (RIETE)","volume":"91","author":"Lopez\u2010Jimenez L.","year":"2006","journal-title":"Haematologica"},{"key":"e_1_2_14_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2003.12.024"},{"key":"e_1_2_14_56_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.seminhematol.2013.03.020"},{"key":"e_1_2_14_57_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2005-12-015222"},{"key":"e_1_2_14_58_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.22170"},{"key":"e_1_2_14_59_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.13415"},{"key":"e_1_2_14_60_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-015-2485-x"},{"key":"e_1_2_14_61_1","volume-title":"ASH57th Annual Meeting and exposition","author":"Morbieu C.","year":"2015"},{"key":"e_1_2_14_62_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2014-05-578336"},{"key":"e_1_2_14_63_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0142217"},{"key":"e_1_2_14_64_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2014.114660"},{"key":"e_1_2_14_65_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-08-302984"},{"key":"e_1_2_14_66_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2141.2003.04547.x"},{"key":"e_1_2_14_67_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0037-1613261"},{"key":"e_1_2_14_68_1","first-page":"Abstract 3294","article-title":"Efficacy and safety of eltrombopag in elderly patients with chronic immune thrombocytopenia: analysis of five clinical trials","volume":"118","author":"Olney H.J.","year":"2011","journal-title":"Blood (ASH Annual Meeting Abstracts)"},{"key":"e_1_2_14_69_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2011-11-393975"},{"key":"e_1_2_14_70_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0037-1615599"},{"key":"e_1_2_14_71_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V97.9.2549"},{"key":"e_1_2_14_72_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2009-06-225565"},{"key":"e_1_2_14_73_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2141.1999.01305.x"},{"key":"e_1_2_14_74_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-03-276691"},{"key":"e_1_2_14_75_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.13444"},{"key":"e_1_2_14_76_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.13330"},{"key":"e_1_2_14_77_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2008-07-162503"},{"key":"e_1_2_14_78_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.12371"},{"key":"e_1_2_14_79_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.12636"},{"key":"e_1_2_14_80_1","doi-asserted-by":"publisher","DOI":"10.1160\/TH08-06-0418"},{"key":"e_1_2_14_81_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.24068"},{"key":"e_1_2_14_82_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V89.8.2689"},{"key":"e_1_2_14_83_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2009.07615.x"},{"key":"e_1_2_14_84_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tmrv.2013.05.004"},{"key":"e_1_2_14_85_1","doi-asserted-by":"publisher","DOI":"10.1111\/ejh.12586"},{"key":"e_1_2_14_86_1","doi-asserted-by":"publisher","DOI":"10.4239\/wjd.v6.i8.1073"},{"key":"e_1_2_14_87_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2015.00030"},{"key":"e_1_2_14_88_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-151-8-200910200-00008"},{"key":"e_1_2_14_89_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.leukres.2014.09.010"},{"key":"e_1_2_14_90_1","doi-asserted-by":"publisher","DOI":"10.1080\/09537100802315110"},{"key":"e_1_2_14_91_1","first-page":"504","article-title":"Long\u2010term follow\u2010up of idiopathic thrombocytopenic purpura in 310 patients","volume":"86","author":"Vianelli N.","year":"2001","journal-title":"Haematologica"},{"key":"e_1_2_14_92_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2012.075648"},{"key":"e_1_2_14_93_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2015-07-659656"},{"key":"e_1_2_14_94_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2009-07-229815"},{"key":"e_1_2_14_95_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.22266"},{"key":"e_1_2_14_96_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-012-1567-2"}],"container-title":["British Journal of Haematology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fbjh.14067","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bjh.14067","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,2]],"date-time":"2023-10-02T13:10:33Z","timestamp":1696252233000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/bjh.14067"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,4,7]]},"references-count":95,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2016,6]]}},"alternative-id":["10.1111\/bjh.14067"],"URL":"https:\/\/doi.org\/10.1111\/bjh.14067","archive":["Portico"],"relation":{},"ISSN":["0007-1048","1365-2141"],"issn-type":[{"value":"0007-1048","type":"print"},{"value":"1365-2141","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,4,7]]},"assertion":[{"value":"2016-04-07","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}