Our patient is in haematology outpatient clinic.

We have excluded any secondary causes for an isolated thrombocytopenia and are considering first line therapy with prednisolone 1mg/kg/day with gastric protection (our local #TeamHaem preference).

We have considered the potential risks of starting glucocorticoid therapy in our patient. We have recognised that osteoporosis needs to be assessed and have found a new good practice guideline from BSH to help!

So #TeamHaem… using the flowchart below, what should we do?

Questions:

1. What general advice would you give to any patient commencing steroid therapy?

1. If indicated, please calculate the FRAX score (https://www.sheffield.ac.uk/FRAX/tool.aspx) for our patient and make recommendations about her risk of glucocorticoid-induced osteoporosis

1. What action would you take given our patient’s calculated risk?

References:

Hill, Q. A., Grainger, J. D., Thachil, J. , Provan, D. , Evans, G. , Garg, M. , Bradbury, C. , Bagot, C. , Kanis, J. A., Compston, J. E. and , (2019), The prevention of glucocorticoid‐induced osteoporosis in patients with immune thrombocytopenia receiving steroids: a British Society for Haematology Good Practice Paper. Br J Haematol. doi:10.1111/bjh.15735