Immune thrombocytopenic purpura
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| Immune thrombocytopenic purpura | |
|---|---|
| Diagnosis in short | |
|
| |
| Synonyms | immune thrombocytopenia |
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| 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) |
| Site | systemic - see spleen |
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| |
| 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.
General
Presentation:
- Bleeding - usually.[1]
Blood work:
- Thrombocytopenia.
- Antiplatelet antibodies.
Treatment:
Prevalence:
- Uncommon.
Classification
- Primary - diagnosis of exclusion.
- Secondary.
- Autoimmune.
- Viral.
- Bacterial - possibly Helicobacter pylori.[4]
Gross
Features:[5]
- Typically ~ 100 grams.
- +/-Prominent white nodules (AKA Malpighian corpuscles) - uncommon.
Microscopic
Features:[5]
- 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.[5]
- † May be a finding associated with treatment.[5]
- The classic changes are proliferation of lymphoid germinal centres and red pulp PMNs.
Images
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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. Lymphoid follicles do not show significant expansion. splenic vessels are hyalinized.
See also
References
- ↑ 1.0 1.1 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.
- ↑ 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.
- ↑ 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/.
- ↑ 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/.
- ↑ 5.0 5.1 5.2 5.3 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/.