Treatments for Primary Immune Thrombocytopenia: A Review

Abstract

Immune thrombocytopenic purpura (ITP) is an autoimmune condition that affects nearly 1:10,000 people in the world. It is traditionally defined by a platelet count of less than 100 x 109L, but treatment typically depends on symptomology rather than on the platelet count itself. For primary idiopathic ITP, corticosteroids have been the standard first-line of treatment for symptomatic patients, with the addition of intravenous immune globulin (IVIG) or Rho(D) immune globulin (anti-RhD) for steroid-resistant cases. In cases of refractory or non-responsive ITP, second-line therapy includes splenectomy or rituximab, a monoclonal antibody against the CD20 antigen (anti-CD20). In patients who continue to have severe thrombocytopenia and symptomatic bleeding despite first- and second-line treatments, the diagnosis of “chronic refractory ITP” is appropriate, and third-line treatments are evaluated. This manuscript describes the efficacy of different treatment options for primary ITP and introduces the reader to various third-line options that are emerging as a means of treating chronic refractory ITP.

Could Intravenous Immunoglobulin Collected from Recovered Coronavirus Patients Protect against COVID-19 and Strengthen the Immune System of New Patients?

“…IVIg has been used to treat patients with autoimmune and chronic inflammatory diseases, such as dermatomyositis, Kawasaki disease, multiple sclerosis, lupus, chronic lymphocytic leukemia, and idiopathic thrombocytopenic purpura [16][17][18]. Furthermore, IVIg has also been used as an anti-infectious agent against viruses, bacteria, and fungi in human patients and experimental models [13,[19][20][21].…”

Severe immune thrombocytopenic purpura in critical COVID-19

“…Furthermore, it is the first case of COVID-19 associated ITP showing relative resistance to first-line ITP agents, as all other reported cases presented platelet count improvement within few days after IVIG administration [5,6]. Although we administered therapies that have been previously used to increase platelet production in refractory cases that are at high risk of bleeding, we believed we observed a late response to first-line agents, since second-line agents did not have time to show any significant clinical effect [4,11].…”

The blood cells count in leukocyte and leukocyte-poor platelet-concentrated plasma in patients with musculoskeletal disorders

“…Since the number of platelets in the whole blood of healthy adults varies in a relatively wide range of 150-450•10 6 cells/mL, this factor must be taken into account in the production of all types of platelet concentrates [16]. In addition, in some diseases, including immune thrombocytopenia and chronic leukocyte leukemia, the platelet number in the blood is reduced to 100•10 6 cells/mL and less [41,42]. When studying the correlation between the platelets count in whole blood and in the prepared concentrates, the products were divided into two groups according to the number of platelets in the processed blood.…”