Current treatment options for primary immune thrombocytopenia

Salama, Abdulgabar

doi:10.1586/ehm.10.76

Cited by 21 publications

(17 citation statements)

References 112 publications

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“…A similar phenomenon occurs in ITP patients following transfusion of high doses of platelets [25] and coating of autologous red blood cells with antibodies, i.e. anti-D [26]. Another factor leading to the normalization in platelet turnover is the direct effect of Tpo RA on regulatory T-cell activity.…”

Section: Disclosure Statementmentioning

confidence: 74%

Platelet Kinetics in Idiopathic Thrombocytopenic Purpura Patients Treated with Thrombopoietin Receptor Agonists

Meyer

Herzig

Salama

2012

Transfus Med Hemother

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Aim: Thrombopoietin receptor agonists (Tpo increase platelet counts in the majority of chronic autoimmune thrombocytopenia (idiopathic thrombocytopenic purpura; ITP) patients. It is unknown whether this treatment may also improve platelet survival (PS) in these patients. Methods: In order to determine platelet survival (PS), autologous platelets were labeled with 111In oxine and retransfused in six patients under treatment with Tpo RA (romiplostim n = 3; eltrombopag n = 3). Results: Stable platelet counts of greater than 100 × 10³/µl were observed in all 6 patients. Platelet survival was decreased in all cases (mean 2.10 days; range 0.13–3.73 days). No correlation was found between platelet count and PS. Similarly, there was no significant relationship between platelet turnover and platelet count. However, a high platelet turnover, exceeding 25 or three times the lowest PS (0.13 or 0.83 days). Two patients had a moderately increased platelet turnover rate (63,072 or 72,872 platelets/µl/day). Conclusion: These results indicate that Tpo RA may not only overcompensate platelet destruction in ITP, but may interfere with other mechanisms, which, in some cases, results in a reduced platelet destruction rate.

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Section: Disclosure Statementmentioning

confidence: 74%

Platelet Kinetics in Idiopathic Thrombocytopenic Purpura Patients Treated with Thrombopoietin Receptor Agonists

Meyer

Herzig

Salama

2012

Transfus Med Hemother

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“…Most AITP patients are asymptomatic in the presence of platelet counts above 50 × 10 9 platelets/L [5]. The clinical manifestation of AITP is extremely variable [4] and, to date, there are no AITPspecific diagnostic markers or disease-specific therapeutic treatments available [6]. AITP embodies a prototype of a B-cell mediated autoimmune lymphoproliferative disease.…”

Section: Introductionmentioning

confidence: 99%

Oxidative Stress Is Predominant in Female but Not in Male Patients with Autoimmune Thrombocytopenia

Kamhieh-Milz

Salama

2014

Oxidative Medicine and Cellular Longevity

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As the involvement of oxidative stress (OS) in autoimmune thrombocytopenia (AITP) has been reported, a fast and rapid test for the reliable measurement of OS and antioxidant capacities (AOCs) might be a useful tool in extending current diagnostic possibilities. The free oxygen radical test (FORT) and free oxygen radical defence (FORD) assay (Callegari, Italy) are easy to perform and reliable, with results available within 15 minutes. Thirty-seven AITP patients and 37 matched healthy individuals were included in this study. All participants responded to a standard questionnaire provided by these assays. Female patients with AITP were observed to demonstrate significantly higher OS in comparison to female controls (P = 0.0027) and male AITP patients (P = 0.0018). The AOCs were not reduced in patients with AITP (P = 0.7648). Correlation of OS with platelet count identified a weak positive correlation (P = 0.0327, Spearman R = 0.4672). The questionnaire revealed that ITP patients in comparison to healthy controls are more stressed, feel exhausted and fatigued, and eat a healthier diet. In conclusion, OS is predominant in female but not in male patients with AITP suggesting gender-specific differences in the pathomechanisms of AITP. Identification of patients with high levels of OS might be beneficial in the management of AITP.

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“…In patients with immune-mediated thrombocytopenia (eg, ITP and DITP), however, platelet transfusions should be restricted to patients with serious or life-threatening bleeding. 47,65 The same accounts for patients with acute HIT or TTP. 85,86 Due to the lack of prospective randomized trials, major uncertainty exists in regard to prophylactic platelet transfusions in ICU patients with thrombocytopenia (with or without disseminated intravascular coagulopathy) and/or platelet function defects without active bleeding at or above WHO grade 2.…”

Section: Platelet Transfusions In Icu Patientsmentioning

confidence: 96%

“…45 In contrast, platelet transfusions are usually not effective, but transfusion of large amounts of platelets can result in cessation of bleeding and even an increased platelet count and are therefore recommended as first-line treatment (in addition to IVIG and corticosteroids) in ITP patients with life-threatening bleeding. 44,46,47 However, in this situation, often more than 5 therapeutic units are required before bleeding is controlled.…”

Section: Commentmentioning

confidence: 99%

How I evaluate and treat thrombocytopenia in the intensive care unit patient

Greinacher

Selleng

2016

Blood

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Multiple causes (pseudothrombocytopenia, hemodilution, increased consumption, decreased production, increased sequestration, and immune-mediated destruction of platelets) alone or in combination make thrombocytopenia very common in intensive care unit (ICU) patients. Persisting thrombocytopenia in critically ill patients is associated with, but not causative of, increased mortality. Identification of the underlying cause is key for management decisions in individual patients. While platelet transfusion might be indicated in patients with impaired platelet production or increased platelet destruction, it could be deleterious in patients with increased intravascular platelet activation. Sepsis and trauma are the most common causes of thrombocytopenia in the ICU. In these patients, treatment of the underlying disease will also increase platelet counts. Heparin-induced thrombocytopenia requires alternative anticoagulation at a therapeutic dose and immune thrombocytopenia immunomodulatory treatment. Thrombocytopenia with symptomatic bleeding at or above World Health Organization grade 2 or planned invasive procedures are established indications for platelet transfusions, while the evidence for a benefit of prophylactic platelet transfusions is weak and controversial. If the platelet count does not increase after transfusion of 2 fresh ABO blood group–identical platelet concentrates (therapeutic units), ongoing platelet consumption and high-titer anti-HLA class I antibodies should be considered. The latter requires transfusion of HLA-compatible platelet concentrates.

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Current treatment options for primary immune thrombocytopenia

Cited by 21 publications

References 112 publications

Platelet Kinetics in Idiopathic Thrombocytopenic Purpura Patients Treated with Thrombopoietin Receptor Agonists

Platelet Kinetics in Idiopathic Thrombocytopenic Purpura Patients Treated with Thrombopoietin Receptor Agonists

Oxidative Stress Is Predominant in Female but Not in Male Patients with Autoimmune Thrombocytopenia

How I evaluate and treat thrombocytopenia in the intensive care unit patient

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