Update on diagnosis and treatment of immune thrombocytopenia

Sandal, Rajeev; Mishra, Kundan; Jandial, Aditya; Sahu, Kamal Kant; Siddiqui, Ahmad Daniyal

doi:10.1080/17512433.2021.1903315

Cited by 30 publications

(20 citation statements)

References 163 publications

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“…Immune thrombocytopenia (ITP), formerly known as idiopathic thrombocytopenic purpura, is an acquired autoimmune disorder characterized by an isolated low platelet count of less than 100 000/µL) [ 1 , 2 ]. The main characteristic of ITP is increased peripheral destruction of platelets, with most patients exhibiting anti-platelet membrane glycoproteins antibodies, while the term chronic ITP refers to cases of ITP which last longer than 12 months [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Initial Thrombocyte Concentrate Transfusion in Woman with Chronic Immune Thrombocytopenia Purpura (ITP) Who Underwent Mitral Valve Replacement Surgery: A Case Report

et al. 2023

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Rare coexistence of disease or pathology Background:Chronic immune thrombocytopenia purpura (ITP) is associated with a higher incidence of adverse outcomes, increased morbidity and mortality rates, and higher health care costs, especially in open-heart surgery. The information regarding managing chronic ITP in patients undergoing mitral valve replacement (MVR) surgery is scarce, and reported cases are limited. Case Report:A 42-year-old woman with more than 20 years of history of immune thrombocytopenia purpura (ITP) had episodes of breathing difficulties in the last 4 years. The patient was diagnosed with severe mitral stenosis (MS) and moderate mitral regurgitation (MR). Laboratory examination before surgery showed thrombocytopenia (49 000/µL). Therefore, the surgery was postponed until the platelet count exceeded 100 000/µL. The patient was given 10 units of thrombocyte concentrate 1 day before surgery and 500 mg of methylprednisolone 3 times a day orally for 5 days as preoperative management. Under a total cardiopulmonary bypass, MVR was performed using a bioprosthetic valve. Postoperative transthoracic echocardiography (TTE) showed no valvular leakage in the surrounding of the prosthetic valve and that the valve was functioning normally. Platelet monitoring was conducted, and the platelet count increased to 147 000/µL on the third day. Conclusions:Our case report shows that aggressive preoperative platelet count correction and treatment may lower the risk associated with a low and unstable platelet count and reduce the risk of mortality and morbidity in patients with ITP who undergo MVR procedures.

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Section: Discussionmentioning

confidence: 99%

Initial Thrombocyte Concentrate Transfusion in Woman with Chronic Immune Thrombocytopenia Purpura (ITP) Who Underwent Mitral Valve Replacement Surgery: A Case Report

et al. 2023

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“…There is no specific test used to diagnose ITP. In most cases, primary ITP is a diagnosis of exclusion made by a careful history, physical examination, complete blood count, and peripheral smear examination [7,8].…”

Section: Early Onlinementioning

confidence: 99%

Fast platelet recovery is associated with remission in primary immune thrombocytopenia

HATİP

Ozbalci

Alanoğlu

et al. 2023

The European Research Journal

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Objectives: We aimed to reveal predictors of response and response duration to steroid therapy in first line of treatment in immune thrombocytopenia (ITP). Methods: Fifty patients, who were diagnosed with ITP in hematology department of Suleyman Demirel University Hospital between 2005-2019, who had sufficient clinical and laboratory data, followed up for at least one year and received corticosteroid treatment in first line, were evaluated retrospectively for treatment response time, remission, prognosis on their first line treatment. The patients who maintained remission for more than 12 months was defined as group 1 and those who did not achieve remission or relapsed in less than 12 months were defined as group 2. Results: Twenty-two (44%) patients responded in first 3 days of the treatment, 16 (32%) patients in 4 to 7 days and 4 (8%) patients responded in more than 7 days. Eighty-four percent (n = 42) of these patients had complete response to corticosteroid treatment. When the remission maintenances were examined, it was observed that 22 (44%) patients were in remission for more than 12 months, 20 (40%) patients were in remission with treatment but relapsed before 12 months and 8 (16%) patients did not respond to corticosteroid treatment. When the response time to treatment in patients with or without remission was compared, remission was significantly lower in those who responded late to treatment (p = 0.01). When the response rates to corticosteroid treatment of patients in group 1 and 2 were evaluated, it was found that the response time to treatment was not related to the maintenance of remission (p = 0.267). Conclusions: Faster response time to treatment produced higher remission rates but, we could not find any relationship between response time to treatment and duration of remission.

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“…Jika pasien tidak didapatkan respon yang membaik berupa perbaikan klinis dan peningkatan jumlah hitung trombosit dengan terapi kortikosteroid dan IVIG, maka dapat dipertimbangkan terapi lini kedua seperti rituximab dan trombopoetin reseptor agonis bahkan sampai pertimbangan dilakukan splenektomi pada kasus trombositopenia yang refrakter. 7 Komplikasi mayor yang juga dapat timbul yaitu pada fetus, dimana dapat terjadi fetal trombositopenia akibat transfer transplasental dari ibu ke bayi melalui sirkulasi uteroplasental. Hal ini berisiko meningkatkan kejadian perdarahan intrakranial pada fetal.…”

Section: Trombositopenia Pada Kehamilanunclassified

Manajemen Anestesi Perioperatif pada Kehamilan dengan Trombositopenia

Wundiawan¹,

Wiryana

2023

JAOI

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Trombositopenia dalam kehamilan adalah suatu kondisi dimana jumlah hitung trombosit kurang dari 150.000 /µL dan bisa terjadi secara fisiologis. Pada kasus kehamilan dengan trombositopenia, ada kalanya diperlukan terminasi kehamilan melalui operasi seksio sesarea. Manajemen anestesi dengan pembiusan umum dikhawatirkan berdampak buruk pada janin akibat obat atau agen anestesi yang digunakan, sedangkan manjemen anestesi dengan pembiusan regional dikhawatirkan berdampak buruk pada ibu yaitu risiko terjadinya neuraksial hematom dengan komorbid trombositopenia. Pemilihan teknik manajemen anestesi perioperatif didasarkan pada penilaian klinis pasien dan jumlah hitung trombosit dengan rentang batasan minimal yang aman untuk dilakukan tindakan regional anestesi (neuraksial) adalah 75.000 /µL–80.000 /µL. Pada kasus yang dilakukan manajemen anestesi dengan pembiusan umum, dapat dipertimbangkan dilakukan induksi dengan pemberian opioid untuk menekan dan menumpulkan rangsang simpatis saat dilakukan laringoskopi intubasi yang bertujuan mencegah komplikasi seperti perdarahan intra-serebral. Trombositopenia pada kehamilan dapat memperberat kehamilan itu sendiri namun pada umumnya persalinan berjalan lancar dan memberikan hasil akhir yang baik. Kolaborasi antara interdisiplin secara komprehensif dan holistik diperlukan untuk menangani kasus ini mulai dari perencanaan tindakan, tatalaksana dan pencegahan komplikasi pada ibu dan janin. Tidak diragukan lagi, kasus gravida dengan trombositopenia merupakan tantangan unik bagi tim anestesi. Dengan terus berkembangnya ilmu dan penelitian dibidang ini, masih perlu dibuat panduan dan batasan yang jelas terkait manajemen perioperatif pada pasien gravida dengan trombositopenia.

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Update on diagnosis and treatment of immune thrombocytopenia

Cited by 30 publications

References 163 publications

Initial Thrombocyte Concentrate Transfusion in Woman with Chronic Immune Thrombocytopenia Purpura (ITP) Who Underwent Mitral Valve Replacement Surgery: A Case Report

Initial Thrombocyte Concentrate Transfusion in Woman with Chronic Immune Thrombocytopenia Purpura (ITP) Who Underwent Mitral Valve Replacement Surgery: A Case Report

Fast platelet recovery is associated with remission in primary immune thrombocytopenia

Manajemen Anestesi Perioperatif pada Kehamilan dengan Trombositopenia

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