There were no procedural deaths, but sepsis was common and 2 of the 6 complete responders died within a year. Howard J, Hoffbrand AV, Prentice HG, Mehta A. Mycophenolate mofetil for the treatment of refractory auto-immune haemolytic anemia and auto-immune thrombocytopenia purpura. ITP occurs in 1 per 1000 to 1 per 10 000 pregnancies, accounting for approximately 3% of women who are thrombocytopenic at delivery.76  In addition to the differential diagnosis common to all patients with possible ITP, consideration should be given to causes of thrombocytopenia confined to or more common during pregnancy, including pregnancy-induced hypertension and related conditions such as hemolysis, elevated liver enzymes, and low platelet count (HELLP), obstetric causes of disseminated intravascular coagulation, microangiopathic hemolytic processes, and gestational thrombocytopenia, among others (for a review, see McCrae et al77 ). Shehata N, Burrows R, Kelton JG. Christiaens GCML, Niewenhuis HK, Bussel JB. Gaines AR. Provan D, Newland A, Bolton-Maggs P, et al. Does treatment with intermittent infusions of IV anti-D allow a proportion of adults with recently diagnosed immune thrombocytopenic purpura (ITP) to avoid splenectomy? 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. All febrile illnesses demand careful evaluation and intravenous antibiotics should be provided urgently at the onset of any systemic illness with fever of 38°C (101°F) or higher until bacterial sepsis can be excluded. However, it is also important to point out that precipitous falls are seen on occasion and demand more intensive therapy with its attendant complications. I Diplomati ITP devono essere Inseriti in GAE. ricorso inserimento gae; ricorso tfa sostegno 2019: accesso alla prova scritta; ricorso per l’inserimento nelle g.i. Therapy of adult ITP following splenectomy. Search for other works by this author on: George JN, Vesely SK. We suggest patients wear a MedAlert bracelet. Antiphospholipid antibodies and antiphospholipid syndrome in patients presenting with immune thrombocytopenic purpura: a prospective cohort study. We only perform bone marrow examinations as a matter of routine in otherwise typical patients if they are over 60 years of age when the incidence of MDS becomes significant, in those who do not show a robust response (> 50 000 × 109/L) to treatment, and often prior to splenectomy if not previously performed. Pubblicato il 30/09/2019 30/09/2019 Pubblicato il ARTICOLI, News. McMillan R, Wang L, Tani P. Prospective evaluation of the immunobead assay for the diagnosis of adult chronic immune thrombocytopenic purpura (ITP). If a complete response occurs to oral therapy, we give full doses for an additional 3 months and then strongly consider stopping treatment. Aggiornamento GAE: Graduatorie a Luglio 05 Giugno 2019 Aggiornamento GAE: Ultimi giorni per presentare la Domanda 18 Maggio 2019 Ragionieri in Graduatoria: Scarica la Domanda 16 Maggio 2019 Diplomati ITP in GAE: Cosa Fare 15 Maggio 2019 Proroga Domande GAE al 20 Maggio: Nota Miur Oggi risponderemo a una domanda che molti dei nostri lettori ci pongono frequentemente ovvero: Come faccio ad inserirmi nelle graduatorie? Responses typically require 1 to 3 months. Such preferences must be respected. Huhn RD, Fogarty PF, Nakamura R, et al. Nessuno sarà mai inserito in GAE né in II fascia. American Academy of Pediatrics Committee on Infectious Diseases. E a quale GPS? Solo pochi giorni fa si è avuto il pronunciamento del Tar del Lazio sulla questione degli ITP in seconda fascia: ecco cosa è stato deciso. The major known long-term risk of splenectomy is overwhelming bacterial sepsis, which occurs in less than 1% of adults with uncomplicated ITP.55  We immunize our patients with polyvalent pneumoccocal, H influenzae type b, and quadrivalent meningococcal polysaccharide vaccines at least 2 weeks prior to splenectomy if possible,56,57  although our experience is that most patients respond to vaccination given more than 6 weeks after surgery. 3) inserimento in GAE ITP : con un ordinanza del TAR che riteneva abilitante il diploma ITP si è scatenata la corsa degli avvocati a proporre ricorsi per inserimento in GAE … Shashaty GG, Rath CE. George JN, Raskob GE, Vesely SK, et al. 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. Scuola, docenti ITP: è un momento particolare questo, per gli insegnanti tecnico pratici (ITP). Approximately 85% of patients attain a hemostatic response after splenectomy and two thirds achieve a durable response (for reviews, see Kojouri et al48  and Schwartz et al49 ). These assays lack sufficient sensitivity to exclude a diagnosis of ITP18-20  and interlaboratory reproducibility is inadequate.21. Decreto di depennamento dalle GaE del personale docente di scuola dell’Infanzia e Primaria – anni 2014/2017 e 2019/22. Contro ogni pronostico è stato affermato il diritto dei Diplomati ITP ad entrare in GAE. Non sono un legale, ma non mi è parso di capire in queste "storiche pronunce giudiziare" che gli ITP abbiano diritto ad essere inseriti in GAE. Osservatorio Docenti e il responsabile legale, Avv.Giuseppe Buonanno, hanno conseguito un ulteriore importantissima vittoria innanzi al Tar Lazio Roma che sarà utile a consentire agli appartenenti alla categoria ITP di essere inseriti nelle GAE o Graduatorie d’Istituto nella classe (dichiarata ad esaurimento) A066 (o in quelle immediatamente compatibili). Il legale sottolinea il fatto che il docente ITP in questione potrà partecipare al prossimo ed imminente piano delle assunzioni a seguito del proprio inserimento nelle GAE. Idiopathic thrombocytopenic purpura, neonatal alloimmune thrombocytopenia, and post-transfusion purpura. In questo articolo ti parliamo di una figura poco conosciuta del mondo della scuola, il docente ITP: si tratta dell’Insegnante Tecnico Pratico. We also initiate general measures to reduce the risk of bleeding, including cessation of drugs that impair platelet function, control of blood pressure, measures to minimize trauma, and measures to reduce mucosal bleeding, such as ϵ-aminocaproic acid (100 mg/kg loading dose up to a maximum of 5 g given intravenously over 30-60 minutes followed by up to 5 g every 6 hours intravenously or orally [maximum dose = 24 g/day]) and, on occasion, desmopressin acetate (DDAVP; 0.3 μg/kg). Gli ITP inseriti tramite ricorso, che fine faranno? The patient should be informed that no antenatal maternal measurements reliably predict the neonatal platelet count, nor does the maternal response to treatment guarantee a favorable neonatal outcome; conversely, women requiring considerable therapy to manage their platelet count should not assume their neonate has an inordinate risk of bleeding. 6 Gender disparity largely disappears among the elderly. If there is sufficient time, one option is cyclosporine (1.25-2.5 mg/kg/dose orally every 12 hours, adjusted based on drug and creatinine levels); in one study, 5 complete and 5 partial remissions were noted in 18 patients who had undergone splenectomy, but 30% of patients discontinued treatment due to side effects (hypertension, myalgias, and headaches).68  High-dose cyclophosphamide (1.0-1.5 g/m2 intravenously) given at 4-week intervals may act more rapidly.67  A high fluid intake (3-4 L daily either orally or intravenously during and for at least 3 days after therapy) and frequent blood counts are necessary. Le tesi sostenute dal Sindacato Asset Scuola hanno centrato ancora una volta nel segno. Diploma ITP in GAE! Ideally, maternal platelet counts should be maintained above 20 000 × 109/L throughout pregnancy and above 50 000 × 109/L near term to minimize the need for platelet transfusions in the event an emergency cesarean section is required,2,3,79  but a higher platelet count may be required for epidural anesthesia. ricorso per ottenere equiparazione stipendiale docenti sostegno ii grado diplomati. Song S, Crow AR, Siragam V, Freedman J, Lazarus AH. We explain that platelet counts commonly fall even during normal pregnancy, and a woman with ITP may start from a lower baseline. ITP remains a diagnosis of exclusion. 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. I ricorrenti riceveranno nei prossimi giorni copia della decisione, e le relative istruzioni per Clinically significant newly presenting autoimmune thrombocytopenic purpura in adults: a prospective study of a population-based cohort of 245 patients. 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. Fujimura K, Harada Y, Fujimoto T, et al. Il mancato invio di tutta la documentazione determina l’impossibilità di procedere al ricorso e lo studio legale è sollevato da qualsiasi responsabilità in caso di mancato invio della documentazione nei termini richiesti. Splenectomy remains the single best option to convert a patient with ITP into a “nonpatient,” that is, one who is unlikely to need frequent monitoring or intervention, and it minimizes interference with a normal lifestyle. IV anti-D and platelet transfusions may be given as needed; repeated or continuous platelet transfusions may be required in urgent situations; all 3 modalities given prior to transfusions may help preserve their longevity in the circulation. Although rare, major bleeding has been reported at platelet counts between 20 000 and 30 000 × 109/L. Comparison of platelet counts in first and second newborns of mothers with immune thrombocytopenic purpura. Only prior neonatal outcome provides a useful predictor of neonatal platelet count in subsequent pregnancies.88  However, 4 of 6 women who previously delivered severely thrombocytopenic infants treated with IVIG weekly for the last 6 weeks of pregnancy delivered less affected neonates (J.B.B., unpublished data, 2005). Chi volesse aderire al ricorso collettivo per l'inserimento in Gae invii una email di PRE-Adesione con i propri dati anagrafici oltre che un recapito telefonico alla mail dell'Associazione associazione.ddl@gmail.com Furthermore, counts may drop suddenly at any time.24  A worrisome number of patients who developed ICH did so after acute and often unpredictable events such as viral infection or head trauma, or after inadvertently taking medications that impair platelet function.27  We would argue that the goal of therapy must be individualized on the basis of signs and symptoms, tolerance of treatment, lifestyle, and patient preference. ricorso inserimento in gae 2019 itp. Prospective evaluation of usefulness of an antigen-specific assay (MAIPA) in idiopathic thrombocytopenic purpura and other immune thrombocytopenia. The long-term effect of treatment on immune surveillance is unknown. N400/2017 *** Dopo la recente e storica vittoria presso il Tribunale del Lavoro, che ha inserito nelle GAE i docenti abilitati ITP vengono riaperti i termini … Per gli ITP infatti non è richiesta solo l’abilitazione, ma anche l’iscrizione nelle graduatorie (GaE o II fascia di istituto) entro il 31 maggio 2017 (data di entrata in vigore del d.lgs. In a recent 10-year study of 310 patients in whom treatment was generally used only at platelet counts less than 30 000 × 109/L, only one hemorrhagic death occurred.22  In a meta-analysis of 17 studies, the age-adjusted risk of fatal hemorrhage at platelet counts persistently less than 30 000 × 109/L was estimated to be 0.4%, 1.2%, and 13% per patient per year for those younger than 40, 40 to 60, and older than 60 years of age, respectively. Weisz B, Meirow D, Schiff E, Lishner M. Impact and treatment of cancer during pregnancy. 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. In one study responses lasting 1 to 39 months were noted in 15 of 23 patients with minimal toxicity64 ; the response rate in refractory patients is undoubtedly lower. Docenti ITP in seconda fascia dopo sentenze negative. Gaines AR. Doan CA, Bouroncle BA, Wiseman BK. Bruno Ventura - 4 Settembre 2019. All others can be treated as outpatients. Options are limited, alternative therapies are toxic, the minority of patients respond, and morbidity and mortality are considerable, approaching 10% to 15% in some series.24-26  We generally reserve the treatments we describe for patients who are clearly refractory to previously mentioned modalities (ie, splenectomy, danazol, rituximab, or immunosuppressants) and who have had serious morbidity or have extremely low platelet counts (eg, less than 10 000 × 109/L). 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. Figure 1 shows our treatment algorithm for initial management. We do not recommend lifelong use of phenoyxmethylpenicillin (250-500 mg orally twice daily) or erythromycin (500 mg orally twice daily) in otherwise healthy adults, in contrast to others.3  Revaccination for pneumococcus is recommended every 5 to 10 years. Prospective screening of 205 patients with ITP, including diagnosis, serological markers, and the relationship between platelet counts, endogenous thrombopoietin, and circulating anti-thrombopoietin antibodies. Thrombocytopenia recurs in most patients when corticosteroids are tapered. Marked discrepancies between the neonatal and maternal platelet count are not uncommon. VEDI ANCHE: Concorso ITP 2020 - Bando, requisiti, come partecipare, cosa studiare In quali scuole e quali materie possono insegnare gli ITP. The response to cyclophosphamide or azathioprine in patients who did or did not respond to the other agent is unknown. 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. Rarely, do patients present with bleeding disproportionate to the platelet count because of antibody-induced platelet dysfunction.29  Some patients experience untoward and otherwise unexplained fatigue when their platelet count is low. Entriamo nel dettaglio. ϵ-Aminocaproic acid can be used as a supplement for oral, nasal, plastic, and prostate surgery. Michel M, Cooper N, Jean C, Frissora C, Bussel JB. 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. Il Ministero dell’Istruzione con Decreto Ministeriale del 24 aprile 2019, n. 374 (doc. Initial treatment of immune thrombocytopenic purpura with high-dose dexamethasone. Chi volesse aderire al ricorso collettivo per l'inserimento in Gae invii una email di PRE-Adesione con i propri dati anagrafici oltre che un recapito telefonico alla mail dell'Associazione associazione.ddl@gmail.com In general, immediate therapy is not required for patients with platelet counts between 20 000 and 50 000 × 109/L in the absence of bleeding or predisposing comorbid conditions such as uncontrolled hypertension, active peptic ulcer disease, anticoagulation, recent surgery, or head trauma.2,3  We recommend maintaining platelet counts above 40 000 to 50 000 × 109/L for patients requiring aspirin, nonsteroidal anti-inflammatory drugs, warfarin, or other antithrombotics. Proton pump inhibitors should be given when corticosteroids are used for more than a few weeks. 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 We test for antiphospholipid antibodies if there is a history thrombosis, recurrent or second- or third-trimester gestational failure, or a prolonged activated partial thromboplastin time.10,16  Up to 5% to 10% of patients eventually meet criteria for systemic lupus erythematosus or another cause of secondary immune thrombocytopenia.17  Our approach to secondary immune thrombocytopenia, including systemic lupus erythematosus, antiphospholipid syndrome, B-cell malignancies (primarily chronic lymphocytic and large granular leukemias), and HIV infection, among others, has been reviewed elsewhere.4, We do not rely on measuring antiplatelet antibodies to make or exclude a diagnosis of ITP. Un’altro ostacolo, questa volta riguarda gli ITP che chiedevano l’ingresso in GaE? Solo pochi giorni fa si è avuto il pronunciamento del Tar del Lazio sulla questione degli ITP in seconda fascia: ecco cosa è stato deciso. Thrombocytopenia may worsen initially. Per maggiori informazioni consultare i seguenti allegati: Sentenza. +++ RICORSO COLLETTIVO ITP in GAE +++ Agli ITP diplomati entro il 2001/02. We have seen rare dramatic responses to ex vivo perfusion of plasma over staphylococcal protein A columns, but its efficacy is far less than reported and its use is limited by potentially severe side effects. The efficacy and safety of B-cell depletion with anti-CD20 monoclonal antibody in adults with chronic immune thrombocytopenia purpura. 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. e/o in GAE sono numerosi, in tanti hanno fatto anche ricorso per partecipare al concorso per docenti abilitati 2018 e in alcuni casi il Consiglio di Stato si è espresso favorevolmente ammettendoli con riserva . From the Departments of Pathology and Laboratory Medicine and Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, and Departments of Pediatrics, Medicine, and Obstetrics and Gynecology, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY. doi: https://doi.org/10.1182/blood-2004-12-4598, Our goal is to set forth our opinion of the best approach to managing adults with primary idiopathic (autoimmune) thrombocytopenic purpura (ITP), with emphasis on the word “opinion.” The paucity of evidence-based medicine on this topic has been noted.1  Both the American Society of Hematology2  and the British Committee for Standards in Haematology General Haematology Task Force3  have issued “practice guidelines.” These, in large part, proved to be compendia of opinions from panels of experienced physicians who concurred on some matters but not on others. Godeau B, Durand J-M, Roudot-Thoraval F, et al. Drugs that interfere with platelet function are discontinued. We generally use corticosteroids as initial therapy, but this can induce or exacerbate gestational diabetes, bone loss, hypertension, and perhaps abruption and prematurity.80  For this reason, we tend to rely more on IVIG together with low-dose prednisone (20 mg every day) than in nonparous patients. Intracranial hemorrhage associated with idiopathic thrombocytopenic purpura: report of seven patients and a meta-analysis. Cortelazzo S, Finazzi G, Buelli M, Molteni A, Viero P, Barbui T. High risk of severe bleeding in aged patients with chronic idiopathic thrombocytopenic purpura. Our opinion is that it is as unreasonable to apply a “one-size fits all” threshold as it would be to attempt to normalize platelet counts in all patients. Elderly patients are more likely to have severe bleeding and to suffer debilitating side effects of therapy.90  It is our practice to look for an accessory spleen with magnetic resonance imaging or another sensitive scanning method (eg, heat-damaged red cells) if the response to splenectomy was durable.49. ITP in Gae o II fascia GI. Portiejle JEA, Westendorp RGJ, Kluin-Nelemans HC, Brand A. Morbidity and mortality in adults with idiopathic thrombocytopenic purpura. 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.