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Immune Thrombocytopenia (ITP)

Immune thrombocytopenia (ITP) is a bleeding disorder. In ITP, the blood doesn't clot as it should. This is due to a low number of blood cell fragments called platelets or thrombocytes. NIH - National Heart, Lung, and Blood Institute

Immune Thrombocytopenia

Immune thrombocytopenia (THROM-bo-si-toe-PE-ne-ah), or ITP, is a bleeding disorder. In ITP, the blood doesn't clot as it should. This is due to a low number of blood cell fragments called platelets (PLATE-lets) or thrombocytes (THROM-bo-sites).

Platelets are made in your bone marrow along with other kinds of blood cells. They stick together (clot) to seal small cuts or breaks on blood vessel walls and stop bleeding.

Overview

Without enough platelets, bleeding can occur inside the body (internal bleeding) or underneath or from the skin (external bleeding).

People who have ITP often have purple bruises called purpura (PURR-purr-ah). These bruises appear on the skin or mucous membranes (for example, in the mouth). Bleeding from small blood vessels under the skin causes purpura.

People who have ITP also may have bleeding that causes tiny red or purple dots on the skin. These pinpoint-sized dots... Read more about Immune Thrombocytopenia

What works? Research summarized

Evidence reviews

[Effectiveness and safety of middle and low-dose gamma globulin for severe idiopathic thrombocytopenic purpura: a systematic review]

Bibliographic details: Li Z, Yilidaer A, Zhang ZG, Halida Y.  [Effectiveness and safety of middle and low-dose gamma globulin for severe idiopathic thrombocytopenic purpura: a systematic review]. Chinese Journal of Evidence-Based Medicine 2014; 14(3): 312-319 Available from: www.cjebm.org.cn/oa/DArticle.aspx?type=view&id=20140303

The efficacy of different dose intravenous immunoglobulin in treating acute idiopathic thrombocytopenic purpura: a meta-analysis of 13 randomized controlled trials

The purpose of this study was to compare the effects of different dose intravenous immunoglobulin for treatment of acute idiopathic thrombocytopenic purpura. Randomized controlled trials (RCTs) comparing high-dose intravenous immunoglobulin (HD-IVIG) with low-dose intravenous immunoglobulin (low-IVIG) for acute idiopathic thrombocytopenic purpura (ITP) were identified using a predefined search strategy. Effective rate, time of cessation of bleeding, time of platelet count beginning to rise, platelet count by the first week of treatment, the number of platelets after 2 weeks of treatment, time of platelet count to reach peak, peak value of platelet count after treatment, side-effects and rate of developing into chronic ITP were extracted and compared by RevMan 4.2.8 (The Cochrane Collaboration, Oxford, UK). Thirteen RCTs (646 patients) were identified. Meta-analysis showed that effective rate, time of cessation of bleeding, time of platelet count beginning to rise, platelet count by the first week of treatment, the number of platelets after 2 weeks of treatment, time of platelet count to reach peak, peak value of platelet count after treatment and rate of developing into chronic ITP were not statistically different between the two different treatment administrations. However, low-IVIG was associated with a significantly reduced risk of side-effects {odds ratio (OR) 0.39 [95% confidence interval (CI) 0.18-0.83]; P = 0.01]. In conclusion, low-IVIG can be performed as effectively as HD-IVIG without increasing the rate of developing into chronic ITP. Furthermore, the low-IVIG regimen can have fewer side-effects than HD-IVIG administration in patients with acute ITP.

Rituximab before splenectomy in adults with primary idiopathic thrombocytopenic purpura: a meta-analysis

Primary immune thrombocytopenia (ITP) is an acquired immune-mediated disorder with absence of any underlying cause. Corticosteroids are the standard initial treatment. Splenectomy is the main second-line treatment. A trend to delay or avoid splenectomy has developed thanks to new agents like rituximab. Few studies have assessed the response rate to rituximab in chronic ITP. We performed the first meta-analysis of randomized clinical trials and observational studies on rituximab as an effective splenectomy-avoiding option in adult chronic ITP. Overall methods were adapted from published guidelines for meta-analysis (meta-analysis of observational studies in epidemiology and preferred reporting items for systematic reviews and meta-analyses). Two haematologist investigators carried out study selection and data extraction independently, recording overall response rate (ORR) and complete response (CR) as primary assessment criteria. Of 364 records were identified through electronic databases. Of 19 retrospective or prospective observational studies were retained after removing duplicate studies and full-text analyses. The ORR was 57% (95% confidence interval [CI]: 48-65), for 368 non-splenectomized patients after rituximab; CR was 41% (95% CI: 0·33-0·51) for 346 patients. Results were stable for ORR and CR in all sub-analyses. In univariate or multivariate mixed-effect meta-regression, age was the most relevant effect. According to our results, rituximab should be used in earlier in non-splenectomized patients.

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Summaries for consumers

Drug therapy for treating idiopathic thrombocytopenic purpura during pregnancy

Idiopathic thrombocytopenic purpura (ITP) is an immune‐mediated hematologic disorder caused by a low blood platelet count (thrombocytopenia). Antiplatelet antibodies act against the platelets resulting in platelet destruction by the spleen. In adults, the clinical features of ITP often have an insidious onset and are highly variable, ranging from no symptoms, mild bruising, to mucosal bleeding, and skin discolorations. Management of ITP during pregnancy is complex because of large differences between maternal and fetal platelet counts. The circulating antibodies can cross the placenta and cause a neonatal passive immune thrombocytopenia that may increase the risk of cerebral haemorrhage in the newborn infant. For this reason, it seems reasonable that cesarean section delivery is safer for the infant than vaginal delivery yet the mode of delivery may not affect the rate of haemorrhage. Many different pharmacological interventions are used for treating this medical disorder and treatment for ITP in pregnant women is not standardised. Some of these drugs have potential side effects for pregnant women and some can cause fetal malformation.

TPO receptor agonists for treating chronic idiopathic thrombocytopenic purpura

Chronic idiopathic thrombocytopenic purpura (ITP) is an acquired autoimmune disorder characterized by low platelet counts. To date, the therapies that primarily aim to reduce platelet destruction, such as corticosteroids, intravenous immunoglobulins and splenectomy, have been the mainstay of treatment in ITP. However, TPO receptor agonists such as romiplostim and eltrombopag, which aim to enhance platelet production, are novel drugs that have been suggested to be more effective. This review included six trials with 808 patients and compared TPO receptor agonists with placebo or standard of care (SOC).

Frequency of heparin‐induced thrombocytopenia in postoperative patients according to type of heparin

Heparin is a natural agent with antithrombotic action. Two types of heparins are widely used, unfractionated heparin (UFH) and low molecular weight heparin (LMWH). Heparin‐induced thrombocytopenia (HIT) is an adverse reaction that can occur during treatment with heparin. It is common in practice and its most important consequence is a paradoxical increase in the risk of thromboembolic complications. The frequency of HIT is still poorly understood. A number of factors are thought to influence its frequency, including the type of heparin and the type of patient exposed; postoperative patients are at higher risk. This review aimed to compare the risk of HIT in postoperative patients exposed to UFH or LMWH. A better understanding of this problem should contribute to safer management of postoperative patients who need thromboprophylaxis with heparin.

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Terms to know

Autoimmune Disease
Disease that results when the immune system mistakenly attacks the body's own tissues. Examples include multiple sclerosis, type 1 diabetes, rheumatoid arthritis, and systemic lupus erythematosus.
Blood Plasma
The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma.
Bone Marrow
The soft, sponge-like tissue in the center of most bones. It produces white blood cells, red blood cells, and platelets.
Idiopathic
A medical term meaning "of unknown cause".
Macrophages
A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells.
Petechiae
Pinpoint, unraised, round red spots under the skin caused by bleeding.
Platelets (Thrombocytes)
A tiny piece of cell that is made by breaking off of a large cell in the bone marrow. Platelets are found in the blood and spleen. They help form blood clots to slow or stop bleeding, and to help wounds heal. Also called thrombocyte.

More about Immune Thrombocytopenia

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Also called: Immune thrombocytopaenia, Immune thrombocytopenic purpura, Autoimmune thrombocytopenic purpura

See Also: Thrombocytopenia

Other terms to know: See all 7
Autoimmune Disease, Blood Plasma, Bone Marrow

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