Immune Thrombocytopenia (ITP): Adult Perspective
Keywords:
ITP, Autoantibodies, Corticosteroids, IV Ig, Thrombopoietin receptor agonists
Abstract
Immune thrombocytopenia (ITP) is an important clinical entity with a mortality rate of about 5% and is notoriously chronic in adult population. Since it is a diagnosis of exclusion, it becomes very important for the clinicians to follow recent guidelines regarding the diagnosis, categorisation and treatment of this clinical entity, so as to reduce the morbidity and mortality. This article provides the insight into understanding the pathophysiological and management aspects of this clinical entity in the light of recent changes and advances that have taken place over the recent past. How to define and categorise ITP, how to search for the possible cause, which drug to use and when to use it, are a few of the issues, which have been addressed in this article.
References
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15. Zhang W, Nardi MA, Borkowsky W, Li Z, Karpatkin S. Role of molecular mimicry of hepatitis C virus protein with platelet GPIIIa in hepatitis C-related immunologic thrombocytopenia. Blood. 2009; 113:4086–4093.
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27. Scaradavou A, Woo B, Woloski BM, et al. Intravenous anti- D treatment of immune thrombocytopenic purpura: experience in 272 patients. Blood. 1997; 89:2689–2700.
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29. Kojouri K, Vesely SK, Terrell DR, George JN. Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications. Blood. 2004; 104:2623–2634.
30. Centres for Disease Control and Prevention (CDC). Recommended adult immunization schedule—United States, 2011. MMWR Morb Mortal Wkly Rep 2011; 60:1–4.
31. Federal Drug Administration. FDA warning. [Accessed September 14, 2014]. http://www.fda.gov/Drugs/DrugSafety/ DrugSafetyNewsletter/ucm115974.htm#Rituximabmarkete dasRituxan:ProgressiveMultifocalLeukoencephalopathyP ML.
32. Bussel JB, Cheng G, Saleh MN, et al. Eltrombopag for the treatment of chronic idiopathic thrombocytopenic purpura. N Engl J Med. 2007;357(22):2237-2247.
33. Kuter DJ, Bussel JB, Lyons RM, et al. Efficacy of romiplostim in patients with chronic immune thrombocytopenic purpura: a double-blind randomised controlled trial. Lancet. 2008;371(9610):395-403.
34. Cheng G, Saleh MN, Marcher C, et al. Eltrombopag for management of chronic immune thrombocytopenia (RAISE): a 6-month, randomised, phase 3 study. Lancet. 2011; 377:393– 402.
35. Bussel J, Kuter D, Pullarkat V, et al. Safety and efficacy of long-term treatment with romiplostim in thrombocytopenic patients with chronic ITP. Blood [INTERNET] 2009 March [Cited 2009 March 5]; 113(1). Available from: http://www. bloodjournal.org/content/113/10/2161?ijkey=f477e5f9a3a0fa 22e9e090c147581e2787368fb0&keytype2=tf_ipsecsha#DC3.
36. Passweg JR, Rabusin M. Hematopoetic stem cell transplantation for immune thrombocytopenia and other refractory autoimmune cytopenias. Autoimmunity. 2008; 41:660–665.
37. Magrin S, Craxi A, Fabiano C, et al. Hepatitis C viremia in chronic liver disease: relationship to interferon-alpha or corticosteroid treatment. Hepatology. 1994; 19:273–279.
38. Rodeghiero F, Stasi R, Gernsheimer T, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 2009; 113(11):2386-2393.
impaired platelet production and increased platelet clearance. J Clin Invest. 1987; 80:33–40
2. Gernsheimer T. Chronic idiopathic thrombocytopenic purpura: mechanisms of pathogenesis. Oncologist. 2009; 14:12– 21.
3. Stasi R, Amadori S, Osborn J, Newland AC, Provan D. Long-term outcome of otherwise healthy individuals with incidentally discovered borderline thrombocytopenia. PLoS Med 2006; 3:e24.
4. Rodeghiero F, Stasi R, Gernsheimer T, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009; 113:2386– 2393.
5. Cines DB, Blanchette VS. Immune thrombocytopenic purpura. N Engl J Med. 2002; 346:995–1008
6. McCrae K. Immune thrombocytopenia: No longer ‘idiopathic’. Cleveland Clinic Journal Of Medicine. 2011; 78 :358-373
7. Aster RH. Molecular mimicry and immune thrombocytopenia (comment). Blood. 2009; 113:3887–3888.
8. Takahashi T, Yujiri T, Shinohara K, et al. Molecular mimicry by Helicobacter pylori CagA protein may be involved in the pathogenesis of H. pylori-associated chronic idiopathic thrombocytopenic purpura. Br J Haematol. 2004; 124:91–96.
9. Nardi MA, Liu LX, Karpatkin S. GPIIIa-(49-66) is a major pathophysiologically relevant antigenic determinant for anti-platelet GPIIIa of HIV-1-related immunologic thrombocytopenia. Proc Natl Acad Sci. U S A 1997; 94:7589–7594.
10. Zhang W, Nardi MA, Borkowsky W, Li Z, Karpatkin S. Role of molecular mimicry of hepatitis C virus protein with platelet GPIIIa in hepatitis Crelated immunologic thrombocytopenia. Blood. 2009; 113:4086–4093.
11. Stoll D, Cines DB, Aster RH, Murphy S. Platelet kinetics in patients with idiopathic thrombocytopenic purpura and moderate thrombocytopenia. Blood. 1985; 65:584–588.
12. Ballem PJ, Segal GM, Stratton JR, Gernsheimer T, Adamson JW, Slichter SJ. Mechanisms of thrombocytopenia in chronic autoimmune thrombocytopenic purpura. Evidence of both impaired platelet production and increased platelet clearance. J Clin Invest. 1987; 80:33–40.
13. Sarpatwari A, Bennett D, Logie JW, et al. Thromboembolic events among adult patients with primary immune thrombocytopenia in the United Kingdom General Practice Research Database. Haematologica. 2010; 95:1167–1175.
14. Stasi R, Willis F, Shannon MS, Gordon-Smith EC. Infectious causes of chronic immune thrombocytopenia. Hematol Oncol Clin North Am. 2009; 23:1275–1297.
15. Zhang W, Nardi MA, Borkowsky W, Li Z, Karpatkin S. Role of molecular mimicry of hepatitis C virus protein with platelet GPIIIa in hepatitis C-related immunologic thrombocytopenia. Blood. 2009; 113:4086–4093.
16. Peck-Radosavljevic M. Thrombocytopenia in liver disease. Can J Gastroenterol. 2000; 14(suppl D):60D–66D.
17. Roomer R, Hansen BE, Janssen HL, de Knegt RJ. Thrombocytopenia and the risk of bleeding during treatment with peginterferonalfa and ribavirin for chronic hepatitis C. J Hepatol. 2010; 53:455–459.
18. Stasi R, Sarpatwari A, Segal JB, et al. Effects of eradication of Helicobacter pylori infection in patients with immune thrombocytopenic purpura: a systematic review. Blood. 2009; 113:1231–1240.
19. Cines DB, Bussel JB, Liebman HA, LuningPrak ET. The ITP syndrome: pathogenic and clinical diversity. Blood. 2009; 113:6511–6521.
20. Zent CS, Kay NE. Autoimmune complications in chronic lymphocytic leukaemia (CLL). Best Pract Res Clin Haematol. 2010; 23:47–59.
21. Hepburn AL, Narat S, Mason JC. The management of peripheral blood cytopenias in systemic lupus erythematosus. Rheumatology. (Oxford) 2010; 49:2243–2254.
22. George JN. Definition, diagnosis and treatment of immune thrombocytopenic purpura. Haematologica. 2009; 94:759– 762.
23. Provan D, Stasi R, Newland AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010; 115:168–186.
24. Cindy N, Wendy L, Mark C, Alan C, Lawrence S Jr. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood [Internet] 2011 April [Cited 2011 April 21]; 117 (16). Available from: http://www.bloodjournal.org/content/117/16/4190. full.print?sso-checked=true#T3.
25. Bromberg ME. Immune thrombocytopenic purpura— the changing therapeutic landscape. N Engl J Med. 2006; 355:1643–1645.
26. Cooper N. Intravenous immunoglobulin and anti-RhD therapy in the management of immune thrombocytopenia. Hematol Oncol Clin North Am. 2009; 23:1317–1327.
27. Scaradavou A, Woo B, Woloski BM, et al. Intravenous anti- D treatment of immune thrombocytopenic purpura: experience in 272 patients. Blood. 1997; 89:2689–2700.
28. Newman GC, Novoa MV, Fodero EM, et al. A dose of 75 microg/kg/d of i.v. anti-D increases the platelet count more rapidly and for a longer period of time than 50 microg/kg/d in adults with immune thrombocytopenic purpura. Br J Haematol. 2001;112(4):1076-1078.
29. Kojouri K, Vesely SK, Terrell DR, George JN. Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications. Blood. 2004; 104:2623–2634.
30. Centres for Disease Control and Prevention (CDC). Recommended adult immunization schedule—United States, 2011. MMWR Morb Mortal Wkly Rep 2011; 60:1–4.
31. Federal Drug Administration. FDA warning. [Accessed September 14, 2014]. http://www.fda.gov/Drugs/DrugSafety/ DrugSafetyNewsletter/ucm115974.htm#Rituximabmarkete dasRituxan:ProgressiveMultifocalLeukoencephalopathyP ML.
32. Bussel JB, Cheng G, Saleh MN, et al. Eltrombopag for the treatment of chronic idiopathic thrombocytopenic purpura. N Engl J Med. 2007;357(22):2237-2247.
33. Kuter DJ, Bussel JB, Lyons RM, et al. Efficacy of romiplostim in patients with chronic immune thrombocytopenic purpura: a double-blind randomised controlled trial. Lancet. 2008;371(9610):395-403.
34. Cheng G, Saleh MN, Marcher C, et al. Eltrombopag for management of chronic immune thrombocytopenia (RAISE): a 6-month, randomised, phase 3 study. Lancet. 2011; 377:393– 402.
35. Bussel J, Kuter D, Pullarkat V, et al. Safety and efficacy of long-term treatment with romiplostim in thrombocytopenic patients with chronic ITP. Blood [INTERNET] 2009 March [Cited 2009 March 5]; 113(1). Available from: http://www. bloodjournal.org/content/113/10/2161?ijkey=f477e5f9a3a0fa 22e9e090c147581e2787368fb0&keytype2=tf_ipsecsha#DC3.
36. Passweg JR, Rabusin M. Hematopoetic stem cell transplantation for immune thrombocytopenia and other refractory autoimmune cytopenias. Autoimmunity. 2008; 41:660–665.
37. Magrin S, Craxi A, Fabiano C, et al. Hepatitis C viremia in chronic liver disease: relationship to interferon-alpha or corticosteroid treatment. Hepatology. 1994; 19:273–279.
38. Rodeghiero F, Stasi R, Gernsheimer T, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 2009; 113(11):2386-2393.
Published
2019-08-31
How to Cite
Dr. Prashant Sharma,. (2019). Immune Thrombocytopenia (ITP): Adult Perspective. The Indian Practitioner, 68(3), 39-45. Retrieved from https://articles.theindianpractitioner.com/index.php/tip/article/view/661
Section
Review article
