There is room for disagreement in each of these cases, but they illustrate the types of issues confronted in real practice. Neylon AJ, Saunders PWG, Howard MR, Proctor SJ, Taylor PRA, on behalf of the Northern Regional Haematology Group. Azathioprine (Imuran) and pregnancy. Disturbances in thyroid function occur with sufficient frequency that we often measure thyroid-stimulating hormone levels if there are complaints of persistent fatigue and prior to splenectomy. For patients who do not respond to rituximab, we generally initiate therapy with at least 2 agents to avoid inducing multiple drug resistance genes.62  This approach also permits the more problematic agent to be tapered first. Dopo queste storiche pronunce, la Direzione Nazionale del Sindacato ASSET Scuola ha deciso di aprire i termini di adesione al ricorso per l’inserimento in Gae dei Diplomati ITP fino al Giorno 31 Dicembre 2020 (data di spedizione della documentazione). 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. Gaines AR. Alkylating agents should be avoided or minimized (total dose of cyclophosphamide < 2000 mg/m2) in younger adults and those wishing to have children, whereas other medications may adversely affect comorbid conditions (eg, corticosteroids and bone density or danazol and prostate disease). In the absence of symptoms or treatment, we monitor platelet counts at least monthly through the first 2 trimesters, biweekly in the third, weekly as term approaches and more often, if indicated. Weisz B, Meirow D, Schiff E, Lishner M. Impact and treatment of cancer during pregnancy. 59/2017). Comparison of platelet counts in first and second newborns of mothers with immune thrombocytopenic purpura. Graduatorie ad Esaurimento aa.ss. IV anti-D can be substituted for prednisone in Rh+ and direct antiglobulin-negative patients intolerant of corticosteroids or who have contraindications to their use.40,41  Therapy with prednisone can be supplemented with IVIG (1.0 g/kg/d for 1-2 days), IV anti-D (50-75 μg/kg), or IV methylprednisolone (1 g) if platelet counts remain below 20 000 × 109/L or if there is another need for a more rapid response. Le tesi sostenute dal Sindacato Asset Scuola hanno centrato ancora una volta nel segno. Stasi R, Pagano A, Stipa E, Amadori S. Rituximab chimeric anti-CD20 monoclonal antibody treatment for adults with chronic idiopathic thrombocytopenic purpura. Entriamo nel dettaglio. Before splenectomy in Rh+ patients, we have combined IVIG and IV anti-D, which act through different IgG-Fcγ receptors,34-36,63  with vincristine and methylprednisolone,37  and platelet transfusions (bolus followed by continuous infusion as needed) for life- or organ-threatening bleeding or after head trauma.38  Recombinant factor VIIa may be added in patients unresponsive to other modalities if an immediate response is necessary, such as with ICH.39  IVIG is generally well tolerated other than for a postinfusion headache. Cohen YC, Djulbegovic B, Shamai-Lubovitz O, Mozes B. Inserire nel plico la copia del bonifico effettuato. Scuola, docenti ITP: è un momento particolare questo, per gli insegnanti tecnico pratici (ITP). Cooper N, Stasi R, Cunningham-Randles S, et al. Sono un ITP con ricorso per l’inserimento in GaE in attesa di risposta; posso iscrivermi? Con questa clamorosa decisione il Tribunale di Torino ha disposto un nuovo cambio di rotta rispetto all’inserimento in GAE dei Diplomati ITP. Supplenze; Supplenze scuola 2020/21 e graduatorie provinciali: indicazioni per ITP e docenti inseriti in Gae. Monitoring bone density or prophylactic treatment is indicated to avoid osteoporosis in patients treated chronically (> 6 months) with corticosteroids. Fujimura K, Harada Y, Fujimoto T, et al. itp itp . Aledort LM, Hayward CP, Chen MG, Nichol JL, Bussel J. Le GaE sono in via di pubblicazione, mentre la seconda fascia delle GI sarà pubblicata a settembre. The largest reported experience involves 14 patients with refractory ITP who were more than 6 months after transplantation at the time of publication.74  Of these, 6 attained stable platelet counts that were greater than 100 000 × 109/L and 2 had partial responses (follow-up 9-42 months). 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. In the largest series to date, 25% to 30% of patients showed responses lasting longer than 1 year.47  Alternatives, including anti-CD20 (rituximab) or danazol are discussed (see “First-line therapy” and “Second-line therapy,” respectively). We do not use danazol, cyclophosphamide, anti-CD20, vinca alkaloids, and other potentially teratogenic therapy (with the possible exception of azathioprine for which a registry exists for renal transplant recipients83 ). 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. Is 20 000 to 30 000 × 109/L a safe and appropriate platelet count for the 63-year-old man with angina who then suddenly requires clopidogrel and aspirin after a coronary stent is placed? George JN, Woolf SH, Raskob GE, et al. Fetal thrombocytopenia and its relation to maternal thrombocytopenia. ricorso inserimento gae; ricorso tfa sostegno 2019: accesso alla prova scritta; ricorso per l’inserimento nelle g.i. 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. Conversely, a poor response to treatment may necessitate re-evaluation of the diagnosis, including a bone marrow examination. I Diplomati ITP devono essere Inseriti in GAE. High P-glycoprotein-mediated export observed in patients with a history of idiopathic thrombocytopenic purpura. La sentenza che state postando ho già detto che è clamorosamente sbagliata e sarà di certo appellata dal Miur per non creare precedenti, e il Consiglio di Stato la riformerà al 100%. Provan D, Newland A, Bolton-Maggs P, et al. Ricorso per l’Inserimento in Gae dei Docenti ITP a: undisclosed-recipients:; 10/02/2017 20:30:47 Ricorso per l’Inserimento in Gae dei Docenti ITP Il Sindacato Asset Scuola non è rimasto sordo di. Other symptoms of ITP … Warner MN, Moore JC, Warkentin TE, Santos AV, Kelton JG. Disseminated intravascular coagulation associated with acute hemoglobinemia or hemoglobinuria following Rh0 (D) immune globulin intravenous administration for immune thrombocytopenic purpura. Long-term follow-up of idiopathic thrombocytopenic purpura in 310 patients. 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. There is no consensus concerning the optimal duration of corticosteroid treatment. A seguire, dunque, analizzeremo una per una tutte le CdC per ITP e forniremo per ognuna di esse l'elenco dei diplomi idonei per partecipare ai concorsi per i posti di insegnante tecnico pratico. The response to cyclophosphamide or azathioprine in patients who did or did not respond to the other agent is unknown. These include exposure to drugs, herbs, foods, or other substances (eg, quinine) associated with thrombocytopenia; pseudothrombocytopenia; giant platelets; family history consistent with inherited thrombocytopenia; or symptoms/signs suggestive of an underlying disorder that may cause secondary immune thrombocytopenia. I Diplomati ITP devono essere Inseriti in GAE. Sep 23 2020 Ricorso-Inserimento-In-Gae-2017-Diploma-Anief-Org 2/3 PDF Drive - Search and download PDF files for free. The initial goal of treatment is to attain a hemostatic platelet count (≥ 30 000 × 109/L) while minimizing the toxicity of treatment. 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. 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. ... II FASCIA GPS ITP. Should relapse occur, the decision to restart azathioprine must be balanced against the theoretical risk of complications from long-term use, which appears low based on experience in renal transplantation. We rarely use vinca alkaloids except as adjunctive therapy because responses are almost always transient and treatment with vincristine is complicated by peripheral neuropathy. Idiopathic thrombocytopenic purpura, neonatal alloimmune thrombocytopenia, and post-transfusion purpura. Nessuno sarà mai inserito in GAE né in II fascia. 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. Precedente Articolo precedente: UNESCO 1966: Diritti e Doveri degli Insegnanti. Miur, Consiglio di Stato e Tar del Lazio La vicenda dei diplomati magistrali agita ancora gli animi, e solo pochi giorni fa si è arrivati a un primo risultato per un altro gruppo di docenti, gli Insegnanti Tecnico Pratici. George JN, Raskob GE, Vesely SK, et al. (1) Minimal emergent therapy includes IV methylprednisolone and IVIG. Sonography, computed tomography scanning, or magnetic resonance imaging of the head should be performed in all neonates born with platelet counts less than 50 000 × 109/L even in the absence of symptoms; finding a “silent” ICH demands immediate management and has implications for subsequent pregnancies. Cyclosporin A for the treatment of patients with chronic idiopathic thrombocytopenia purpura refractory to corticosteroids or splenectomy. Berchtold P, Muller D, Beardsley D, et al. Portiejle JEA, Westendorp RGJ, Kluin-Nelemans HC, Brand A. Morbidity and mortality in adults with idiopathic thrombocytopenic purpura. Gestational thrombocytopenia. DiFino SM, Lachant NA, Kirshner JJ, Gottlieb AJ. Approximately 30% to 40% of patients have platelet counts less than 50 000 × 109/L after splenectomy because they did not respond or they had a relapse, whereas others are unable or unwilling to undergo the procedure. Antiphospholipid antibodies and antiphospholipid syndrome in patients presenting with immune thrombocytopenic purpura: a prospective cohort study. Loading... un docente ITP inserito nelle graduatorie di Istituto degli Istituti di Genova e provincia. Clonality and cytogenetics are assessed as part of the bone marrow evaluation. In questo articolo ti parliamo di una figura poco conosciuta del mondo della scuola, il docente ITP: si tratta dell’Insegnante Tecnico Pratico. 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 … However, long-term effects of the procedure on the incidence of occlusive cerebrovascular disease remain under study. Testing for HIV or hepatitis C infection (or both) is indicated in at-risk populations and the latter may occur more widely than previously appreciated.12  Remissions induced by eradication of asymptomatic Haemophilus pylori infection have been reported in studies from Italy and Japan,13,14  but is not our experience.15  We neither perform the more sensitive breath testing nor treat empirically at presentation, but consider testing in chronic cases and those with gastrointestinal symptoms. Danazol therapy in patients with chronic idiopathic thrombocytopenic purpura: long-term results. Gli ITP inseriti tramite ricorso, che fine faranno? Rarely, patients develop aseptic meningitis, acute renal failure, pulmonary insufficiency, thrombosis, or hemolysis; dissolving lyophilized preparations in sterile water to lower osmolarity and slowing the infusion rate may lessen these risks. Our preference is to use azathioprine (2 mg/kg orally every day adjusted to avoid severe neutropenia), preferably in combination with danazol (10-15 mg/kg/d), typically 600-800 mg per day, as the first approach to chronic immunosuppression because the incidence of acute and serious side effects is lower than with cyclophosphamide and the frequency of lasting remissions is comparable (20%-40%).58  However, responses occur more slowly (typically 3-4 months) and this agent, like danazol, is often stopped prematurely. (2) We generally initiate therapy with prednisone and add either IV anti-D (in Rh+, direct antiglobulin-negative patients) or IVIG as needed for persistent severe thrombocytopenia with the goal of attaining a platelet count of greater than 30 000 × 109/L and cessation of bleeding. IVIg-mediated amelioration of murine ITP via FcγRIIB is independent of SHIP1, SHP-1, and Btk activity. We treat patients with persistent ITP with the goal of maintaining the platelet count more than 20 000 to 30 000 × 109/L while avoiding steroid-induced osteoporosis, cataracts, and other toxicities. 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. Di cosa si occupa l’ITP … avviso per i lettori. I ricorsi per essere inseriti in II fascia G.I. Treatment must be continued for 4 to 6 months to see its full effect. Kappers-Klunne MC, van't Veer MB. 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. Ne deriva, di conseguenza, che la vicenda dei docenti ITP ai fini dell’inserimento nelle GAE, è ancora aperta e tale sentenza potrà costituire un importante precedente. Di. Dapsone for chronic autoimmune thrombocytopenic purpura: a report of 66 cases. Does Helicobacter pylori initiate or perpetuate immune thrombocytopenic purpura? 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 … 59/2017). Although splenectomy has been performed safely at exceedingly low platelet counts, nonresponders may experience bleeding problems after the procedure. Mortality rates for open and laparoscopic splenectomy are 1.0% and 0.2%, respectively.48  The outcomes of the 2 approaches are comparable,53  although the former hastens recovery and offers better cosmesis. Samuelsson A, Towers TL, Ravetch JV. Marcaccio MJ. Doan CA, Bouroncle BA, Wiseman BK. Blood 2005; 106 (7): 2244–2251. Laparoscopic splenectomy in chronic idiopathic thrombocytopenic purpura. An open-label, unit dose-finding study evaluating the safety and platelet response of a novel thrombopoietic protein (AMG531) in thrombocytopenic adult patients (pts) with immune thrombocytopenic purpura (ITP) [abstract]. There is limited experience with chemotherapy for neoplastic diseases in pregnant women that may be helpful in managing the truly exceptional case (for reviews, see Koren et al84  and Weisz et al85 ). Burrows RF, Kelton JG. Sono un ITP con ricorso per l’inserimento in GaE in attesa di risposta; posso iscrivermi? von dem Borne AEGK, Vos JJE, Pegels JG, Thomas LLM, van der Lelie H. High dose intravenous methylprednisolone or high dose intravenous gammaglobulin for autoimmune thrombocytopenia. 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). Is the platelet count a reasonable surrogate marker for the risk of serious bleeding? McMillan R, Wang L, Tani P. Prospective evaluation of the immunobead assay for the diagnosis of adult chronic immune thrombocytopenic purpura (ITP). 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. Il Ministero dell’Istruzione con Decreto Ministeriale del 24 aprile 2019, n. 374 (doc. Maternal characteristics and risk of severe neonatal thrombocytopenia and intracranial hemorrhage in pregnancies complicated by auto-immune thrombocytopenia. The efficacy and safety of B-cell depletion with anti-CD20 monoclonal antibody in adults with chronic immune thrombocytopenia purpura. Nation-wide study of idiopathic thrombocytopenic purpura in pregnant women and the clinical influence on neonates. Alternatively, we combine danazol with either azathioprine or mycophenolate mofetil for a minimum of 4 months, if possible, and use corticosteroids or IVIG (or both) in the interim, as needed. Huhn RD, Fogarty PF, Nakamura R, et al. Vesely SK, Perdue JJ, Rizvi MA, Terrell DR, George JN. che, invece, per quanto riguarda i docenti ITP che hanno conseguito il titolo prima della chiusura delle GAE il ricorso – prescindendosi dai profili di inammissibilità del ricorso per non avere i ricorrenti tempestivamente impugnato il D.M. 1) ha fornito le istruzioni per l’aggiornamento triennale delle graduatorie a esaurimento. Fiduciosi delle recenti pronunce favorevoli ottenute, CORSO DIGITALE PER COLLABORATORE SCOLASTICO (ATA), BOOM DI CONVOCAZIONI COME ASSISTENTE TECNICO. Adult idiopathic thrombocytopenic purpura: clinical findings and response to therapy. Marked discrepancies between the neonatal and maternal platelet count are not uncommon. A new approach is the use of thrombopoietic factors. International study to compare antigen-specific methods used for the measurement of antiplatelet autoantibodies. We reserve splenic irradiation for the rare patient in whom splenectomy is indicated but hazardous or as a diagnostic test.54. Dapsone (75-100 mg orally daily) provides results similar to danazol,66  but should be avoided in patients with glucose-6-phosphate dehydrogenase deficiency. Responses are usually noted within 4 to 8 weeks after the first infusion but may occur as late as 4 months. McMillan R. Therapy for adults with refractory chronic immune thrombocytopenic purpura. Decreto di depennamento dalle GaE del personale docente di scuola dell’Infanzia e Primaria – anni 2014/2017 e 2019/22. Inviata da Alessandro Nunzio Marino. The platelet count may fall before a response is seen and granulocyte colony-stimulating factor and prophylactic antibiotics may be needed. Shashaty GG, Rath CE. Many of the symptoms of immune thrombocytopenia (ITP), previously known as idiopathic thrombocytopenia, stem from a low platelet count leading to excessive bleeding. Patients typically present with petechiae or purpura that develop over several days accompanied by platelet counts less than 20 000 × 109/L, although the onset is often more insidious than previously appreciated.10  Severe cutaneous bleeding, prolonged epistaxis, gingival bleeding, overt hematuria, or menorrhagia may develop at platelet counts less than 10 000 × 109/L. Idiopathic thrombocytopenic purpura in the elderly. Newman GC, Novoa MV, Fodero EM, Lesser ML, Woloski BMR, Bussel JB. Studies of anti-tumor necrosis factor α receptor and anti-interleukin 2 receptor antagonists are too preliminary to evaluate. ITP in Gae o II fascia GI. Il docente ITP protagonista del ricorso, era entrato nei ruoli scolastici nell’anno 2001 tramite il cosiddetto doppio canale, sulla classe C270 Laboratorio di Elettrotecnica, anche se il medesimo risultava inserito nelle graduatorie anche sulla classe C290 Laboratorio di Fisica. Song S, Crow AR, Siragam V, Freedman J, Lazarus AH. Most patients achieve this goal, although it may take years25,26  and therapy can be toxic17  if not used judiciously.25,26  There are no randomized trials to support the effectiveness of any specific approach.58  We concur with several of the recommendations of the British Haematology Task Force3  concerning platelet counts for minor surgery (> 50 000 × 109/L) and most major surgery (> 80 000 × 109/L); higher counts are advisable for cardiac bypass surgery, neurosurgery, and complex orthopedic or plastic surgery. What is more contentious and requires individualization and considerable judgment is the wisdom of treating patients with platelet counts between 20 000 and 50 000 × 109/L. Najean Y, Rain J-D, Billotey C. The site of destruction of autologous 111In-labelled platelets and the efficiency of splenectomy in children and adults with idiopathic thrombocytopenic purpura: a study of 568 patients with 268 splenectomies. POSTI DISPONIBILI SUL SOSTEGNO: SCARICA LA TABELLA, CONCORSO DOCENTI 2020: ABILITAZIONE PER CHI PARTECIPA, RIVOLUZIONE SUPPLENZE DOCENTI: COME ENTRARE NEGLI ELENCHI PROVINCIALI, STABILIZZAZIONE DOCENTI: COME ADERIRE AL RICORSO GRATUITO, BONUS DOCENTI PER I PRECARI: COME ADERIRE, MOBILITA’ DOCENTI E ATA: COME OTTENERE IL TRASFERIMENTO, FDP 8 MODULI: LA NUOVA CERTIFICAZIONE PER DOCENTI E ATA. We hospitalize (1) patients with profound mucocutaneous or internal bleeding and (2) those who present with platelet counts of less than 20 000 × 109/L and a history of significant bleeding, those in whom there is a question about compliance, and in some cases, those in whom responsiveness to therapy has not been established—for example, when comorbid factors predisposing to bleeding or complications of therapy are present. Although few otherwise healthy, sedentary individuals die of hemorrhage over a 10-year period if they maintain a stable platelet count more than 20 000 × 109/L and though we rarely treat patients with platelet counts more than 30 000 × 109/L in the absence of extenuating circumstances that predispose to serious bleeding, no published follow-up is of sufficient length or size to project risk over a life span. Consideriamo, in questo articolo gli ITP, una categoria di docenti che può accedere all’insegnamento soltanto con il diploma di scuola secondaria superiore, molti dei quali sono nella III fascia delle graduatorie di Istituto. Levy AS, Cunningham-Rundles S, Mazza B, Simm M, Gorlick R, Bussel J. Il decreto consente la presentazione della domanda (doc. Il ricorso, iscritto al numero di registro generale 7015 del 2017, riguarda un consistente numero di insegnanti che chiedevano l’inserimento in GaE e sembra pure in seconda fascia di istituto. Docenti ITP in seconda fascia dopo sentenze negative. Un’altro ostacolo, questa volta riguarda gli ITP che chiedevano l’ingresso in GaE? ITP should be suspected any time during pregnancy if isolated thrombocytopenia of less than 50 000 × 109/L is detected, especially during the first 2 trimesters, but the distinction from gestational thrombocytopenia may occasionally be problematic in the absence of a prenatal platelet count as both entities are diagnoses of exclusion. In the event of relapse, the long-term risks (eg, secondary malignancy, MDS) must be weighed against the potential benefits of resuming therapy. Letsky EA, Greaves M. Guidelines on the investigation and management of thrombocytopenia in pregnancy and neonatal alloimmune thrombocytopenia. Prospective screening of 205 patients with ITP, including diagnosis, serological markers, and the relationship between platelet counts, endogenous thrombopoietin, and circulating anti-thrombopoietin antibodies. What is a hemostatic platelet count? A prospective study of protein-specific assays used to investigate idiopathic thrombocytopenic purpura. (4) We recommend splenectomy for those clearly requiring therapy beyond 12 months to maintain a hemostatic platelet count and sooner in select individuals intolerant of therapy, with active lifestyles or comorbid risk factors that make higher platelet counts desirable. Stessa sorte per gli ITP e altre categorie di docenti.Sono ormai centinaia i rigetti dei tribunali per l’inserimento in GAE , ma nonostante ciò si continuano a proporre ricorsi senza senso , solo per spillare soldi ai propri associati. Therapy of adult ITP before splenectomy. In our limited experience, patients who responded but had a relapse often respond to subsequent courses. Scaradavou A, Woo B, Woloski BMR, et al. George JN. DOMANDA GAE DIPLOMA ITP 2 DATA _____ FIRMA _____ e che il Ministero dell’Istruzione, dell’Università e della Ricerca provveda ad attivare le apposite funzioni della piattaforma telematica “Istanze on line” anche per il/la sottoscritto/a al fine di Our usual practice is to maintain a somewhat higher platelet count initially (eg, 30 000 × 109/L) while we get to know the patient, with the goal of establishing a track record of bleeding, compliance, and risk management that allows us to modify the threshold for treatment over time. ricorso per ottenere equiparazione stipendiale docenti sostegno ii grado diplomati. We generally treat patients in whom splenectomy fails with the anti-CD20 monoclonal antibody, rituximab (375 mg/m2 intravenously every week for 4 weeks).

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