Difference between revisions of "Immune thrombocytopenic purpura"

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Immune thrombocytopenic purpura (view source)

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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      =
| Width      =
| Caption    =
| Synonyms  = immune thrombocytopenia, idiopathic thrombocytopenic purpura
| Micro      = germinal centres in white pulp (~55% of cases), [[neutrophil]]s in the red pulp (~67% of cases), macrophages in the red pulp
| Subtypes  = clinical: primary, secondary
| LMDDx      =
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      = +/-prominent white nodules (spleen), normal appearance (most common)
| Grossing  = [[splenectomy grossing]]
| Site      = systemic - see ''[[spleen]]''
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  = bleeding
| Prevalence = uncommon
| Bloodwork  = thrombocytopenia, antiplatelet antibodies
| Rads      =
| Endoscopy  =
| Prognosis  = dependent on underlying cause
| Other      =
| ClinDDx    =
| Tx        = corticosteroids, possibly splenectomy
}}
'''Immune thrombocytopenic purpura''', abbreviated '''ITP''', is a rare condition.  
'''Immune thrombocytopenic purpura''', abbreviated '''ITP''', is a rare condition.  
It is also known as ''idiopathic thrombocytopenic purpura''.<ref>URL: [https://medlineplus.gov/ency/article/000535.htm https://medlineplus.gov/ency/article/000535.htm]. Accessed on: 7 September 2016.</ref>


==General==
==General==
*A common non-trauma reason for [[splenectomy]].<ref name=pmid24798604>{{Cite journal  | last1 = Jankulovski | first1 = N. | last2 = Antovic | first2 = S. | last3 = Kuzmanovska | first3 = B. | last4 = Mitevski | first4 = A. | title = Splenectomy for haematological disorders. | journal = Pril (Makedon Akad Nauk Umet Odd Med Nauki) | volume = 35 | issue = 1 | pages = 181-7 | month =  | year = 2014 | doi =  | PMID = 24798604 }}</ref>
Presentation:
*Bleeding - usually.<ref name=pmid23714309>{{cite journal |author=Kistangari G, McCrae KR |title=Immune thrombocytopenia |journal=Hematol. Oncol. Clin. North Am. |volume=27 |issue=3 |pages=495–520 |year=2013 |month=June |pmid=23714309 |doi=10.1016/j.hoc.2013.03.001 |url=}}</ref>
Blood work:
*Thrombocytopenia.
*Antiplatelet antibodies.
Treatment:
*Usually treated with corticosteroids.<ref name=pmid23714309/>
**Possibly retuximab.<ref>{{Cite journal  | last1 = Zhang | first1 = C. | last2 = Liu | first2 = HF. | last3 = Chen | first3 = XH. | last4 = Gao | first4 = L. | last5 = Gao | first5 = L. | last6 = Liu | first6 = Y. | last7 = Kong | first7 = PY. | last8 = Sun | first8 = AH. | last9 = Zhang | first9 = X. | title = Is splenectomy necessary for immune thrombocytopenic purpura? The role of rituximab in patients with corticosteroid resistance in a single-center experience. | journal = Clin Ther | volume = 36 | issue = 3 | pages = 385-8 | month = Mar | year = 2014 | doi = 10.1016/j.clinthera.2014.01.017 | PMID = 24594069 }}</ref>
*Refractory cases get a splenectomy.
Prevalence:
*Uncommon.
*Uncommon.
*Usually treated with corticosteroids and splenectomy.<ref>{{Cite journal | last1 = Zhang | first1 = C. | last2 = Liu | first2 = HF. | last3 = Chen | first3 = XH. | last4 = Gao | first4 = L. | last5 = Gao | first5 = L. | last6 = Liu | first6 = Y. | last7 = Kong | first7 = PY. | last8 = Sun | first8 = AH. | last9 = Zhang | first9 = X. | title = Is splenectomy necessary for immune thrombocytopenic purpura? The role of rituximab in patients with corticosteroid resistance in a single-center experience. | journal = Clin Ther | volume = 36 | issue = 3 | pages = 385-8 | month = Mar | year = 2014 | doi = 10.1016/j.clinthera.2014.01.017 | PMID = 24594069 }}</ref>
 
===Classification===
*Primary - diagnosis of exclusion.
*Secondary.
**Autoimmune.
***[[Systemic lupus erythematosus]].<ref>{{cite journal |author=Cines DB, Liebman H, Stasi R |title=Pathobiology of secondary immune thrombocytopenia |journal=Semin. Hematol. |volume=46 |issue=1 Suppl 2 |pages=S2–14 |year=2009 |month=January |pmid=19245930 |pmc=2682438 |doi=10.1053/j.seminhematol.2008.12.005 |url=}}</ref>
**Viral.
**Bacterial - possibly [[Helicobacter pylori]].<ref name=pmid24574745>{{cite journal |author=Kuwana M |title=Helicobacter pylori-associated immune thrombocytopenia: clinical features and pathogenic mechanisms |journal=World J. Gastroenterol. |volume=20 |issue=3 |pages=714–23 |year=2014 |month=January |pmid=24574745 |pmc=3921481 |doi=10.3748/wjg.v20.i3.714 |url=}}</ref><ref name=pmid25728540>{{Cite journal  | last1 = Frydman | first1 = GH. | last2 = Davis | first2 = N. | last3 = Beck | first3 = PL. | last4 = Fox | first4 = JG. | title = Helicobacter pylori Eradication in Patients with Immune Thrombocytopenic Purpura: A Review and the Role of Biogeography. | journal = Helicobacter | volume = 20 | issue = 4 | pages = 239-51 | month = Aug | year = 2015 | doi = 10.1111/hel.12200 | PMID = 25728540 }}</ref>


==Gross==
==Gross==
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==Microscopic==
==Microscopic==
Features:<ref name=pmid4044880>{{cite journal |author=Hayes MM, Jacobs P, Wood L, Dent DM |title=Splenic pathology in immune thrombocytopenia |journal=J. Clin. Pathol. |volume=38 |issue=9 |pages=985–8 |year=1985 |month=September |pmid=4044880 |pmc=499346 |doi= |url=}}</ref>
Features:<ref name=pmid4044880>{{cite journal |author=Hayes MM, Jacobs P, Wood L, Dent DM |title=Splenic pathology in immune thrombocytopenia |journal=J. Clin. Pathol. |volume=38 |issue=9 |pages=985–8 |year=1985 |month=September |pmid=4044880 |pmc=499346 |doi= |url=}}</ref>
*Macrophages in the red pulp (~25% of cases).
*Germinal centres in white pulp (~55% of cases)  
**Classically described as "proliferative".
*Neutrophils in the red pulp (~67% of cases).
*Neutrophils in the red pulp (~67% of cases).
*Macrophages in the red pulp (~25% of cases). †
Notes:
*Changes not dependent on titre of antiplatelet antibodies.<ref name=pmid4044880/>
*† May be a finding associated with treatment.<ref name=pmid4044880/>
*The classic changes are ''proliferation of lymphoid germinal centres'' and ''red pulp [[PMN]]s''.


===Images===
===Images===
*[http://www.webpathology.com/image.asp?case=376&n=2 ITP spleen (webpathology.com)].
*[http://www.webpathology.com/image.asp?case=376&n=2 ITP spleen (webpathology.com)].
*[http://www.pathpedia.com/education/eatlas/histopathology/spleen/immune_thrombocytopenic_purpura_(itp).aspx ITP spleen (pathpedia.com)].
*[http://www.pathpedia.com/education/eatlas/histopathology/spleen/immune_thrombocytopenic_purpura_(itp).aspx ITP spleen (pathpedia.com)].
==Sign out==
<pre>
Spleen, Splenetectomy:
    - Spleen with prominent red pulp macrophages and expanded germinal
      centres, pending hematopathology consult.
</pre>
===Block letters===
<pre>
SPLEEN, SPLENECTOMY:
- SPLEEN WITH CHANGES COMPATIBLE WITH IMMUNE THROMBOCYTOPENIC PURPURA.
</pre>
===Micro===
The sections show spleen with increased numbers of red pulp macrophages and siderophages.  Rare scattered red pulp neutrophils are seen. Rare plasma cells are seen in the red pulp. Lymphoid follicles do not show significant expansion.


==See also==
==See also==
Michael
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