Universa Medicina warmly welcome the contributions from you about new basic and clinical including modern and epidemiological research on medicine and health. For Authors. Journal Statistics. View My Stats. Psaila B, Bussel T. Idiopathic thrombocytopenic purpura.
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Language: English Turkish. Immune thrombocytopenic purpura ITP is also known as idiopathic thrombocytopenic purpura. Increased platelet destruction and insufficient platelet production are both responsible for its etiopathogenesis.
ITP can be diagnosed after excluding other possible causes of thrombocytopenia. One hundred forty-three cases of chronic ITP that were monitored in a hematology clinic were retrospectively evaluated.
Corticosteroid nonresponsive CN cases and corticosteroid-dependent CD cases underwent splenectomies. Currently, 13 patients are being monitored without treatment. Fifteen patients who were non-responsive to Hp eradication treatment, immunosuppressive treatment or danazol treatment are still being monitored without any treatment. Optimal treatment is not available for splenectomy-resistant cases of ITP.
The response rates for Hp eradication treatment, immunosuppressive treatments and anabolic agents are low. Therefore, larger studies with more patients are required using new agents, such as thrombopoietin TPO receptor agonists and anti-CD20 monoclonal antibodies. Immune thrombocytopenic purpura ITP is also known as idiopathic thrombocytopenic purpura [ 1 ]. No specific criteria are available for the diagnosis of ITP. ITP can be diagnosed after the exclusion of other diseases causing thrombocytopenia.
Therefore, ITP is currently described as a primary immune thrombocytopenia [ 2 , 3 ]. The clinical course of ITP is usually chronic in adults. In cases of chronic ITP, serious bleeding is not expected even with significant thrombocytopenia. Corticosteroids are given as the first line of therapy in ITP cases with serious thrombocytopenia.
Splenectomy is the standard care for cases that are non-responsive to corticosteroids. No consensus is currently available regarding the appropriate treatment of patients with serious thrombocytopenia who require treatment following the splenectomy [ 6 ].
Various post-splenectomy treatments have been administered to refractory patients. Azathioprine, vinka alkaloids, danazol, cyclophosphamide, high dose dexamethasone, rituximab, interferon, and cyclosporine have been used.
The treatment of chronic refractory ITP is difficult because response to treatment is variable. Treatment-related serious side effects may be observed [ 7 ]. Thrombopoietin TPO receptor antagonists and anti-CD20 monoclonal antibodies are new treatment approaches with different mechanisms of action [ 8 , 9 ]. Age, gender, baseline clinical symptoms, platelet count, administered treatment, treatment response, complications and relapse rates of chronic ITP patients admitted to hematology clinics were retrospectively evaluated.
The general patient characteristics are summarized in Table 1. The most common complaints of patients admitted to the hospital were ecchymosis and epistaxis Table 2. One hundred forty-three cases with a platelet count of 1. Eight cases who were admitted with gastrointestinal system GIS and subarachnoid bleeding were not included in this study.
Complete response CR was considered the maintenance of a platelet count within normal ranges without treatment for three months following the discontinuation of prednisolone.
Fifteen of the cases were pregnant. Ten of the pregnant women achieved CR and PR. Two were non-responsive to steroids, and three were dependent on steroids. Splenectomy was performed in two steroid-dependent pregnant patients after delivery, and CR was achieved.
Regarding the preoperative preparation regimen for splenectomy, intravenous immunoglobulin G, steroids, platelet suspension and anti-D were administered to 5, 29, 13 and 3 patients, respectively. Eleven patients were non-responsive to splenectomy, and four cases relapsed. Ten of 41 cases had a positive urea-breath test, and Helicobacter pylori Hp eradication treatment was initiated. Danazol was given to 4 patients, and 13 cases platelet counts in the range of Fifteen cases that were non-responsive to Hp eradication treatment, immunosuppressive treatment or danazol continue to be followed without any treatment.
Table 3 summarizes the treatments and results of patients who did not undergo splenectomies, who relapsed and who were non-responsive to splenectomy. Complications associated with treatment are summarized in Table 4. Mortality and morbidity associated with splenectomy are quite rare [ 10 ]. No life-threatening complications have yet been observed due to the use of steroids or the splenectomy.
Data about the immunosuppressive treatment responses were excluded because the number of patients non-responsive to steroids and splenectomy was low. However, no bleeding symptoms were observed in non-responsive and untreated patients. Therefore, long-term immunosuppressive treatment is unnecessary if the platelet count is over Moreover, the rate of treatment-related mortality may be higher than the rate of bleeding-related mortality [ 11 , 12 ]. Following splenectomy, if the platelet level is between In cases of serious bleeding, intravenous immunoglobulin IVIG , high-dose methylprednisolone, antifibrinolytic agents and platelet transfusion are recommended [ 2 , 5 , 13 , 14 ].
In patients with refractory ITP, Hp eradication treatment has been shown to increase platelet levels [ 16 ]. In conclusion, no optimal treatment is currently available for patients with ITP who are resistant to splenectomy. The response rates of Hp eradication treatment, immunosuppressive treatment and anabolic agents are low. For this reason, larger studies evaluating TPO receptor agonists and anti-CD20 monoclonal antibodies with a large number of recruited subjects are needed.
Ulusal Hematoloji Kongresi. Conflict of interest statement: The authors declare that they have no conflict of interest to the publication of this article.
National Center for Biotechnology Information , U. Journal List Eurasian J Med v. Eurasian J Med. Author information Article notes Copyright and License information Disclaimer. Received Jun 2; Accepted Oct 5. Abstract Objective: Immune thrombocytopenic purpura ITP is also known as idiopathic thrombocytopenic purpura. Materials and Methods: One hundred forty-three cases of chronic ITP that were monitored in a hematology clinic were retrospectively evaluated.
Conclusion: Optimal treatment is not available for splenectomy-resistant cases of ITP. Introduction Immune thrombocytopenic purpura ITP is also known as idiopathic thrombocytopenic purpura [ 1 ].
Materials and Methods Age, gender, baseline clinical symptoms, platelet count, administered treatment, treatment response, complications and relapse rates of chronic ITP patients admitted to hematology clinics were retrospectively evaluated. Table 1.
General characteristics and platelet count of patients on admission. Median Age years 37 15—76 Female ratio Open in a separate window. Findings The most common complaints of patients admitted to the hospital were ecchymosis and epistaxis Table 2.
Table 2. Baseline symptoms and signs. Prevalence Ecchymosis Table 3. Treatment results of cases without splenectomy. Table 4. Treatment related complications. Side effect Patient n Steroids Cushingoid changes 13 Myalgia 5 Acne 2 Disturbance of hepatic functions 1 Splenectomy - - Cyclosporine Hypertension - Cyclophosphamide Disturbance of renal functions 1 Vincristine - - - - Danazol Disturbance of hepatic functions 1.
References 1. Cooper N, Bussel J. The pathogenesis of immune thrombocytopenic purpura. Br J Haematol. George JN. Management of patients with refractory immune thrombocytopenic purpura. Review Article. J Thromb and Haemost. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Definition, diagnosis and treatment of immune thrombocytopenic purpura.
British Committee for Standards in Haematology General Haematology Task Force Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Provan D, Newland A. Fifty years of idiopathic thrombocytopenic purpura ITP : management of refractory itp in adults. Management of adult patients with persistent idiopathic thrombocytopenic purpura following splenectomy: a systematic review.
Ann Intern Med. Efficacy of romiplostim in patients with chronic immune thrombocytopenic purpura: a double-blind randomised controlled trial. Systematic review: efficacy and safety of rituximab for adults with idiopathic thrombocytopenic purpura. Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications. Morbidity and mortality in adults with idiopathic thrombocytopenic purpura.
Clinically significant newly presenting autoimmune thrombocytopenic purpura in adults: a prospective study of a population-based cohort of patients.
IDIOPATIK TROMBOSITOPENIA PURPURA (ITP).pptx
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Upaya Pencegahan Cedera Pada Klien Idiopatik Trombositopenia Purpura Di Rsud Pandan Arang
Diploma thesis, Universitas Muhammadiyah Surakarta. ITP is one reason the incidence of symptomatic bleeding disorder with a range of 3 to 8 per , children in year. In Pandan Arang Boyolali hospital in noted there were 11 children out of children. The actions of defact prevention in ITP is taken to prevent the bleeding. The normal life period of platelet is 7 days, in ITP become days. If ITP patients suffered an defact it would be easy bleeding due to platelet acts as a coagulant factor decreases and affects the process of normal hemostasis, usually characterized by petechiae, ecchymosis, easy bruising, bleeding gums, menorrhagia, nose bleeding and hematuria spontaneously. Intracranial bleeding, soft tissue and mucosal bleeding due to trauma can cause mortality.