Difference between revisions of "Immune thrombocytopenic purpura"

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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>
Blood work:
*Thrombocytopenia.
*Antiplatelet antibodies.


Treatment:
Treatment:
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===Classification===
===Classification===
*Primary.
*Primary - diagnosis of exclusion.
*Secondary.
*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.
**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>{{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>

Revision as of 03:48, 6 May 2014

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

General

Presentation:

  • Bleeding - usually.[1]

Blood work:

  • Thrombocytopenia.
  • Antiplatelet antibodies.

Treatment:

  • Usually treated with corticosteroids.[1]
    • Possibly retuximab.[2]
  • Refractory cases get a splenectomy.

Prevalence:

  • Uncommon.

Classification

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

See also

References

  1. 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.
  2. 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.
  3. 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/.
  4. 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. 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/.