Pulmonary Thromboembolism in Immune Thrombocytopenia: A Report of Five Cases and a Review of the Literature

Tan, Yong Fei; Yan, Min; Zhang, Cheng; Pan, Xiaowen

doi:10.2147/ijgm.s323146

Cited by 5 publications

(5 citation statements)

References 27 publications

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“…ITP patients have increased amounts of platelet and red cell microparticles [107]. Platelet microparticles are involved in thrombosis production through an increased procoagulant activity due to their higher content of large von Willebrand factor multimers that play an important role in platelet aggregation and coagulation [108]. Moreover, PMPs are potentially thrombogenic due to the high surface expression of phosphatidylserine [109].…”

Section: Thrombosis Related To Itp As a Diseasementioning

confidence: 99%

“…Acquired deficiency of natural anticoagulants in ITP patients can be explained by complement activation, through the terminal complement complex that inhibits natural anticoagulant, which results in an increased risk of thrombosis [123]. Tan et al (2021) studied pulmonary thromboembolism in immune thrombocytopenia and showed that the level of antithrombin was deceased and the level of active protein C was increased, suggesting a link between these markers and thrombosis in this clinical context [108].…”

Section: Thrombosis Related To Itp As a Diseasementioning

confidence: 99%

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Immune Thrombocytopenic Purpura as a Hemorrhagic Versus Thrombotic Disease: An Updated Insight into Pathophysiological Mechanisms

et al. 2022

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Immune thrombocytopenic purpura (ITP) is a blood disorder characterized by a low platelet count of (less than 100 × 109/L). ITP is an organ-specific autoimmune disease in which the platelets and their precursors become targets of a dysfunctional immune system. This interaction leads to a decrease in platelet number and, subsequently, to a bleeding disorder that can become clinically significant with hemorrhages in skin, on the mucous membrane, or even intracranial hemorrhagic events. If ITP was initially considered a hemorrhagic disease, more recent studies suggest that ITP has an increased risk of thrombosis. In this review, we provide current insights into the primary ITP physiopathology and their consequences, with special consideration on hemorrhagic and thrombotic events. The autoimmune response in ITP involves both the innate and adaptive immune systems, comprising both humoral and cell-mediated immune responses. Thrombosis in ITP is related to the pathophysiology of the disease (young hyperactive platelets, platelets microparticles, rebalanced hemostasis, complement activation, endothelial activation, antiphospholipid antibodies, and inhibition of natural anticoagulants), ITP treatment, and other comorbidities that altogether contribute to the occurrence of thrombosis. Physicians need to be vigilant in the early diagnosis of thrombotic events and then institute proper treatment (antiaggregant, anticoagulant) along with ITP-targeted therapy. In this review, we provide current insights into the primary ITP physiopathology and their consequences, with special consideration on hemorrhagic and thrombotic events. The accumulated evidence has identified multiple pathophysiological mechanisms with specific genetic predispositions, particularly associated with environmental conditions.

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Section: Thrombosis Related To Itp As a Diseasementioning

confidence: 99%

Section: Thrombosis Related To Itp As a Diseasementioning

confidence: 99%

Immune Thrombocytopenic Purpura as a Hemorrhagic Versus Thrombotic Disease: An Updated Insight into Pathophysiological Mechanisms

et al. 2022

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“…ITP is characterized by the autoantibody-mediated destruction of platelets and the impaired production of platelets from megakaryocytes, [ 3 ] resulting in the decrease of platelet count (<100 × 10 9 /L), [ 4 ] with clinical manifestations of various bleeding tendencies, which is more likely to occur when platelets count <30 × 10 9 /L. [ 1 ] However, it has been reported that patients with this hemorrhagic disease have a risk of thrombosis and embolism in recent years.…”

Section: Discussionmentioning

confidence: 99%

An obvious antinomy, superior sagittal sinus thrombosis in a patient with immune thrombocytopenia: Case report and a review of literatures

2023

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Rationale: Immune thrombocytopenia (ITP) is an autoimmune disease with an increased risk of bleeding. However, in recent years, it has been reported that patients with this hemorrhagic disease have the risk of thrombosis and embolism. Patient concerns and diagnosis: The patient, in this case, was a young female who was diagnosed with ITP. When the platelet count was low, she had skin, mucosa, internal organs, and intracranial hemorrhage. In the process of ITP and hemostatic treatment, superior sagittal sinus thrombosis occurred when she was still bleeding. Interventions: She was given treatments for reducing intracranial pressure and controlling epilepsy. Outcomes: And then the embolectomy operation failed. It was suggested in this case that ITP patients with severe thrombocytopenia and bleeding tendency also have a risk of having thrombotic disease. We reviewed literatures regarding the mechanism of the simultaneous occurrence of 2 antinomy diseases and cerebral venous thrombosis. Lessons: There are many factors for ITP patients to have thrombosis involving ITP itself, its treatment and the patients’ constitution, medical history, and former medication. ITP is not only a hemorrhagic disease but also a thrombotic disease. Clinicians should be alert to the risk of thrombotic diseases in ITP treatment. Therefore thrombus monitoring and screening should be carried out, and early prevention or appropriate anticoagulant treatment should be selected, especially for patients with high risk.

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“…The data of all 15 patients including our case are presented in ►Table 2. 1,[6][7][8][9][10][11][12][13] The underlying pathogenesis behind this prothrombotic tendency in patients with ITP is unclear. 14 Several different possible causes have been suggested including hyperactive immature platelets, 15 platelet microparticles, 14 and dysfunction in complement activation.…”

Section: Discussionmentioning

confidence: 99%

Management of Recurrent Venous Thromboembolism in Severe Immune Thrombocytopenia: A Case Report and a Review of the Literature

Nielsen,

Bor

2023

Hamostaseologie

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We report a case of a 58-year-old man with recurrent unprovoked deep vein thrombosis (DVT) and severe immune thrombocytopenia (ITP) with a platelet count of 19 × 109/L. We further review studies reporting venous thromboembolism (VTE) in patients with severe ITP (≤ 35 × 109/L) and identified 14 patients highlighting VTE risk factors and management of these patients. The present case had several risk factors for VTE (previous DVT, obesity, heterozygosity for factor V Leiden mutation, and previous splenectomy). The patient was initially treated with low-molecular-weight heparin followed by long-term apixaban treatment. The literature review together with our case demonstrates that VTE in severe ITP (≤ 35 × 109/L) can occur in patients with VTE risk factors and antithrombotic management of these patients can be achieved without bleeding depending on severity of thrombocytopenia either by full or reduced dose of anticoagulation together with ITP therapy.

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Pulmonary Thromboembolism in Immune Thrombocytopenia: A Report of Five Cases and a Review of the Literature

Cited by 5 publications

References 27 publications

Immune Thrombocytopenic Purpura as a Hemorrhagic Versus Thrombotic Disease: An Updated Insight into Pathophysiological Mechanisms

Immune Thrombocytopenic Purpura as a Hemorrhagic Versus Thrombotic Disease: An Updated Insight into Pathophysiological Mechanisms

An obvious antinomy, superior sagittal sinus thrombosis in a patient with immune thrombocytopenia: Case report and a review of literatures

Management of Recurrent Venous Thromboembolism in Severe Immune Thrombocytopenia: A Case Report and a Review of the Literature

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