61
Table 8. Hematologic Toxicities
G2: Platelet count 50 to
<75/uL
• Hold ICPi but monitor for improvement. If not
resolved, interrupt treatment until AE has reverted
to G1.
• Administer prednisone 1 mg/kg per day (dosage
range, 0.5–2 mg/kg per day) orally for 4 weeks
followed by taper over 4–6 weeks to the lowest
effective dose.
• IVIG may be used in conjunction with
corticosteroids if a more rapid increase in platelet
count is required.
G3: Platelet count 25–<50/
uL
• As per G2.
• Hematolog y consult.
• Consider as alternative to prednisone,
dexamethasone 40 mg daily for four days.
• If IVIG is used, the dose should initially be 1 g/kg as
a one-time dose.
• If previous treatment with corticosteroids and/or,
IVIG, has been unsuccessful, subsequent treatment
may include rituximab, thrombopoietin receptor
agonists, or more potent immunosuppression.
(From American Society of Hematolog y guideline
on immune thrombocytopenia — consult for further
details)
G4: Platelet count <25/uL
8.7 Acquired Hemophilia A
Workup/Evaluation:
• Hematolog y consult
• Full blood count to assess platelet number, fibrinogen, PT, PTT, INR. The typical
finding in patients with acquired hemophilia A is a prolonged aPTT with a normal
PT.
• MRI, CT, and ultrasonography may be indicated to localize, quantify, and serially
monitor the location and response of bleeding.
• Medication review to assess for alternative causes.
• Determination of Bethesda unit level of inhibitor.
Grading Management
G1: Mild: 5–40% of normal
factor activity in blood;
0.05–0.4 IU/ml of whole
blood
• Hold ICPi and discuss resumption with patient only
after taking into account the risks and benefits.
• Administer 0.5–1 mg/kg/day prednisone.
• Transfusion support as required.
• Treatment of bleeding disorders with hematolog y
consult.
(cont'd)
