Bruising is common. Mucosal bleeding may also occur in more severe cases. Treatment is based on platelet count and bleeding symptoms. Patients with life-threatening bleeding, regardless of platelet count, can be considered for combination therapy with corticosteroids, intravenous immune globulin IVIG , and platelet transfusion.
Rho D immune globulin can also be considered in those who are rhesus-positive and nonsplenectomized. Subsequent treatment with mycophenolate, thrombopoietin receptor agonists, rituximab, fostamatinib adults only , or splenectomy can be considered in patients who are unresponsive to, or intolerant of, initial treatment. Mortality is higher in older patients and in those unresponsive to several lines of treatment.
Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. The pathogenesis of immune thrombocytopaenic purpura. Br J Haematol. The distinction between primary and secondary ITP is clinically relevant because of their different natural histories and distinct treatments, including the need to treat the underlying condition in secondary ITP.
Ivy Altomare, MD: Excellent. Thank you so much. Actually, Ralph, I want to ask you, can you speak a little bit about the mechanism of decreased platelet production that happens in patients with ITP? Ralph V. And I think, Terry, you were instrumental looking at measuring thrombopoietin [TPO] levels a number of years ago in patients who were thrombocytopenic for a variety of different reasons, including aplastic anemia and ITP, and actually showing that there was, if anything, a low level of thrombopoietin often measured, in the laboratory at least, in those patients with ITP compared to, for instance, patients who had aplastic anemia.
And we believe that that has to do with the fact that once bound to the platelets, that destructive process that occurs in the spleen takes the circulating thrombopoietin out of the circulation, therefore the levels will fall. And so not only have we got the destructive process, but we no longer have the stimulant, the thrombopoietin to increase macrophage proliferation differentiation, all the things that it needs to do.
Gernsheimer, MD: If I can add to that, I think one of the very interesting things that we realized was that these same antibodies are binding to that same target that is present on macrophages. Gernsheimer, MD: Yes, because the megakaryocytes are carrying that target and it leads to apoptosis. So not only do we have TPO levels that are not as high as one would expect, but we also have these megakaryocytes just dying.
It just so happens, as we know, the megakaryocyte degenerates into platelets those same epitopes naturally that were there before. January 27, Transcript: Ivy Altomare, MD: Immune thrombocytopenia, without a known cause, is frequently encountered in clinical practice. Ivy Altomare, MD: Sure. Ivy Altomare, MD: No kidding.
He pointed out that the patient would probably be treated with sirolimus, which has been shown to be effective in patients with ITP secondary to ALPS.
Then there's Helicobacter pylori H. Research has shown that eradication of an H. So instead of treating the ITP in these patients, explained Bussel, evidence suggests that by treating the H.
This content was created by Everyday Health Media on behalf of an advertiser. More Information. Content on this page was created or selected by the Everyday Health Media team and is funded by an advertising sponsor. The sponsor may select the topic but does not edit the content. Chronic Immune Thrombocytopenia: Meeting the Challenge.
More On This Topic. A new study found that roughly 1 in 8 patients with immune thrombocytopenia ITP who received a COVID vaccine had severe drops in their platelet count within a few days afterward.
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