Current management of immune thrombocytopenia

Abstract

Immune thrombocytopenia (ITP) is an autoimmune-mediated condition that results from antibody-mediated destruction of platelets and impaired megakaryocyte platelet production. ITP patients exhibit severe thrombocytopenia and are at risk for significant hemorrhage. Few randomized trials exist to guide management of patients with ITP. Ultimately, each patient requires an individualized treatment plan that takes into consideration the platelet count, bleeding symptoms, health-related quality of life, and medication side effects. This article provides an up-to-date review of management strategies drawing on links between the expanding amounts of clinical trial data and associated biology studies to enhance understanding of the disease heterogeneity with regard to the complex pathogenesis and response to treatment.

Safety and efficacy of rituximab in adult immune thrombocytopenia: results from a prospective registry including 248 patients

“…1,2 These autoantibodies can also inhibit megacaryocyte proliferation and maturation with impaired platelet production. The major role of B cells is to produce antibodies.…”

Is There a Role for Low-Dose Eltrombopag as Maintenance Therapy in the Treatment of Immune Thrombocytopenia?

“…Although generally well tolerated [11,12,18,26,27], early adverse effects of eltrombopag include headache, fatigue, nausea, nasopharyngitis [6,18] as well as hepatic dysfunction [8,11,26]. Moreover, eltrombopag treatment has been associated with thromboembolic events [11,18,26] although further research is required to ascertain a direct relationship between these events and the use of thrombopoietin receptor agonists [19,20,21,22]. Bone marrow fibrosis is the main later adverse effect, and its incidence, clinical importance and long-term consequences need to be further investigated [13,18,28,29,30].…”

“…Plausible mechanisms include increased platelet microparticle thrombogenicity following peripheral destruction as well as antiphospholipid antibody activity, which are highly prevalent in adult ITP patients. Lastly, most of the ITP patients who experience a thromboembolic event have additional risk factors for its occurrence, such as hypertension, smoking, diabetes, hospitalization or other treatments [19,22]. In general, eltrombopag was well tolerated and there was no other adverse event than the thrombosis mentioned above.…”

“…It must be stated that the occurrence of the thrombosis cannot be strongly associated with the use of eltrombopag. There is evidence that thrombosis is not dependent upon drug-induced thrombocytosis and can occur in patients with normal or even low platelet counts [19,20,21]. Furthermore, patients with primary ITP are at an increased risk for venous thromboembolic events compared with patients without primary ITP [20,22].…”

Hematoma subdural bilateral frontotemporal em PTI: relato de caso

“…Durante a internação, que aconteceu devido à queixa de cefaleia intensa, a paciente evoluiu com aumento dos níveis plaquetários transitório, porém com piora do quadro de hemorragia cutâneo-mucoso e com cefaleia persistente. Corroborando com a literatura 5,8,10,11,14 , foi mantida a conduta medicamentosa com corticosteroide mesmo com elevação transitória dos níveis plaquetários. Em situações de sangramentos graves, a transfusão de plaquetas pode ser realizada, o que foi realizado neste caso.…”