Difference between revisions of "Immune thrombocytopenic purpura"

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| Width      =
| Width      =
| Caption    =  
| Caption    =  
| Synonyms  = immune thrombocytopenia
| 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
| 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
| Subtypes  = clinical: primary, secondary
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| IF        =
| IF        =
| Gross      = +/-prominent white nodules (spleen), normal appearance (most common)
| Gross      = +/-prominent white nodules (spleen), normal appearance (most common)
| Grossing  =
| Grossing  = [[splenectomy grossing]]
| Site      = systemic - see ''[[spleen]]''
| Site      = systemic - see ''[[spleen]]''
| Assdx      =  
| Assdx      =  
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'''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:
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>
*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>
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***[[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>
***[[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.
**Viral.
**Bacterial - possibly [[Helicobacter pylori]].<ref>{{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>
**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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==Sign out==
==Sign out==
<pre>
Spleen, Splenetectomy:
    - Spleen with prominent red pulp macrophages and expanded germinal
      centres, pending hematopathology consult.
</pre>
===Block letters===
<pre>
<pre>
SPLEEN, SPLENECTOMY:
SPLEEN, SPLENECTOMY:
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===Micro===
===Micro===
The sections show spleen with increased numbers of red pulp macrophages and siderophages.  Rare scattered red pulp neutrophils are seen. Lymphoid follicles do not show significant expansion. splenic vessels are hyalinized.
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==

Latest revision as of 17:19, 7 September 2016

Immune thrombocytopenic purpura
Diagnosis in short
Synonyms immune thrombocytopenia, idiopathic thrombocytopenic purpura
LM germinal centres in white pulp (~55% of cases), neutrophils in the red pulp (~67% of cases), macrophages in the red pulp
Subtypes clinical: primary, secondary
Gross +/-prominent white nodules (spleen), normal appearance (most common)
Grossing notes splenectomy grossing
Site systemic - see spleen
Symptoms bleeding
Prevalence uncommon
Blood work thrombocytopenia, antiplatelet antibodies
Prognosis dependent on underlying cause
Treatment corticosteroids, possibly splenectomy

Immune thrombocytopenic purpura, abbreviated ITP, is a rare condition.

It is also known as idiopathic thrombocytopenic purpura.[1]

General

Presentation:

  • Bleeding - usually.[3]

Blood work:

  • Thrombocytopenia.
  • Antiplatelet antibodies.

Treatment:

  • Usually treated with corticosteroids.[3]
    • Possibly retuximab.[4]
  • Refractory cases get a splenectomy.

Prevalence:

  • Uncommon.

Classification

Gross

Features:[8]

  • Typically ~ 100 grams.
  • +/-Prominent white nodules (AKA Malpighian corpuscles) - uncommon.

Microscopic

Features:[8]

  • Germinal centres in white pulp (~55% of cases)
    • Classically described as "proliferative".
  • 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.[8]
  • † May be a finding associated with treatment.[8]
  • The classic changes are proliferation of lymphoid germinal centres and red pulp PMNs.

Images

Sign out

Spleen, Splenetectomy:
     - Spleen with prominent red pulp macrophages and expanded germinal 
       centres, pending hematopathology consult.

Block letters

SPLEEN, SPLENECTOMY:
- SPLEEN WITH CHANGES COMPATIBLE WITH IMMUNE THROMBOCYTOPENIC PURPURA.

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

References

  1. ↑ URL: https://medlineplus.gov/ency/article/000535.htm. Accessed on: 7 September 2016.
  2. ↑ Jankulovski, N.; Antovic, S.; Kuzmanovska, B.; Mitevski, A. (2014). "Splenectomy for haematological disorders.". Pril (Makedon Akad Nauk Umet Odd Med Nauki) 35 (1): 181-7. PMID 24798604.
  3. ↑ 3.0 3.1 Kistangari G, McCrae KR (June 2013). "Immune thrombocytopenia". Hematol. Oncol. Clin. North Am. 27 (3): 495–520. doi:10.1016/j.hoc.2013.03.001. PMID 23714309.
  4. ↑ Zhang, C.; Liu, HF.; Chen, XH.; Gao, L.; Gao, L.; Liu, Y.; Kong, PY.; Sun, AH. et al. (Mar 2014). "Is splenectomy necessary for immune thrombocytopenic purpura? The role of rituximab in patients with corticosteroid resistance in a single-center experience.". Clin Ther 36 (3): 385-8. doi:10.1016/j.clinthera.2014.01.017. PMID 24594069.
  5. ↑ Cines DB, Liebman H, Stasi R (January 2009). "Pathobiology of secondary immune thrombocytopenia". Semin. Hematol. 46 (1 Suppl 2): S2–14. doi:10.1053/j.seminhematol.2008.12.005. PMC 2682438. PMID 19245930. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2682438/.
  6. ↑ Kuwana M (January 2014). "Helicobacter pylori-associated immune thrombocytopenia: clinical features and pathogenic mechanisms". World J. Gastroenterol. 20 (3): 714–23. doi:10.3748/wjg.v20.i3.714. PMC 3921481. PMID 24574745. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3921481/.
  7. ↑ Frydman, GH.; Davis, N.; Beck, PL.; Fox, JG. (Aug 2015). "Helicobacter pylori Eradication in Patients with Immune Thrombocytopenic Purpura: A Review and the Role of Biogeography.". Helicobacter 20 (4): 239-51. doi:10.1111/hel.12200. PMID 25728540.
  8. ↑ 8.0 8.1 8.2 8.3 Hayes MM, Jacobs P, Wood L, Dent DM (September 1985). "Splenic pathology in immune thrombocytopenia". J. Clin. Pathol. 38 (9): 985–8. PMC 499346. PMID 4044880. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC499346/.
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