{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T10:56:46Z","timestamp":1789729006486,"version":"4.0.1"},"reference-count":33,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T00:00:00Z","timestamp":1695254400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["1K01HL135466"],"award-info":[{"award-number":["1K01HL135466"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Br J Haematol"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>It is known that patients with immune thrombocytopenia (ITP) have fatigue and impairment of health\u2010related quality of life (HRQoL). However, it is hypothesized that patients with refractory ITP have additional burdens that should be considered. Specifically, fatigue is more pronounced in patients with refractory disease, there are additional side effects from second\u2010 and third\u2010line treatments, additional anxiety about the long\u2010term course of the disease, impairment in HRQoL resulting from heavy menstrual bleeding and concerns related to family planning. The burden of disease, therefore, should be carefully assessed and considered in these patients. However, researchers have utilized numerous tools for evaluating HRQoL and fatigue, making comparison of data across studies challenging. There is a need to standardize assessment using either disease\u2010specific or generic instruments that can be easily implemented in routine clinical practice. Additionally, whether treatment of low platelet count and bleeding symptoms will have a positive influence on HRQoL remains to be seen and published evidence is conflicting. Nevertheless, improvement of HRQoL is a major treatment goal for both patients and physicians and should be especially considered when treating patients with refractory ITP.<\/jats:p>","DOI":"10.1111\/bjh.19068","type":"journal-article","created":{"date-parts":[[2023,9,22]],"date-time":"2023-09-22T03:20:29Z","timestamp":1695352829000},"page":"79-85","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Burden of immune thrombocytopenia (<scp>ITP<\/scp>): Special considerations for refractory <scp>ITP<\/scp>"],"prefix":"10.1111","volume":"203","author":[{"given":"Axel","family":"R\u00fcfer","sequence":"first","affiliation":[{"name":"Division of Hematology Luzerner Kantonsspital\u2010in association with University Luzern  Luzern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deirdra R.","family":"Terrell","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and 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