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Overview of ITP
Heather D. Mannuel, MD, MBA
March 12, 2008
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Idiopathic (Immune)
Thrombocytopenic Purpura Thromoc!to"enia in the a#ence of
other
loo$ cell anormalitie# %normal &B' (
)B', normal "eri"heral #mear*
+o clinicall! a""arent con$ition# or
me$ication# that can account forthromoc!to"enia
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tati#tic# of ITP
Inci$ence of 22 million-!ear in one #tu$!
Prevalence reater a# often chronic
*eal et al 100 million-!ear
/aea$u#te$ "revalence .3-100,000 /1. 41 female# -
male#
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'linical Manife#tation#
Ma! e acute or in#i$iou# on#et
Mucocutaneous Bleeding
/"etechiae, "ur"ura, ecch!mo#i#
/e"i#ta5i#, um lee$in
/menorrhaia *GI bleed, CN bleed ! "#"$
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6tiolo! of ITP 4 'hil$ren
Often after in%ection %viral or acterial*
Theorie#4
/antio$! cro##reactivit!
/H. pylori /acterial li"o"ol!#acchari$e#
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6tiolo! of ITP 4 A$ult#
77 Autoantio$ie#7
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Diano#i# (of Exclusion)
&ule out other cau#e#4
/la error - PT clum"in
/$ru - me$ication interaction
/infection# %HI9, He"atiti# '*
/th!roi$ - autoimmune $i#ea#e
/$e#tructive - con#um"tive "roce##e# %TTP-H:*
/one marrow $i#ea#e %leu;emia#, MD*
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Diano#i# (of Exclusion)
&ule out other cau#e#4
/la error - PT clum"in
/$ru - me$ication interaction
/infection# %HI9, He"atiti# '*
/th!roi$ - autoimmune $i#ea#e
/$e#tructive - con#um"tive "roce##e# %TTP-H:*
/one marrow $i#ea#e %leu;emia#, MD*
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To Marrow or +ot to Marrow7
Bone marrow a#"iration ( io"#! if<
Patient =0 !r#. or ol$er
Poorl! re#"on#ive to t5
:nclear clinical "icture
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AntiPlatelet Antio$! Te#tin
N&T recommended by #' Practice
Guidelines
Poor "o#itive-neative "re$ictive value#,"oor #en#itivit! with
all current te#tin
metho$#<
t chane the manaement?
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Manaement of ITP in A$ult#
6merenc! v#. 'hronic T5
@oal "revention of lee$in, +OT cure?
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Manaement of ITP in A$ult#
6merenc! v#. 'hronic T5
@oal "revention of lee$in, +OT cure?
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@eneral Princi"le# of Thera"!
Maor lee$in rare if PT 10,000
@oal et PT count to #afe level to"revent lee$in<
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Cafe Platelet 'ount#
Cmo$eratel! t"enic E030,000
Proal! #afe if a#!m"tomatic
'aution with el$erl! %'+ lee$#*
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)hen Plannin Thera"!<
Tailor thera"! an$ $eci#ion to treat to the
in$ivi$ual "atient
)eih lee$in v#. thera"! ri#;#
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Initial Thera"!
Prednisone mggday
/u#uall! re#"on#e within 2 wee;#
Ta"er off after PT re#"on#e
+uration of u#e controver#ial
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econ$ine Thera"!
I9 Immune @loulin %I9I*
1 ram-;-$a! 5 2 $a!#
)in&ho %antiD* F if "t i# &hG
303 mc-;-$a!
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Treatment i$e6ffect#
teroi$#
/one $en#it! lo## /@I effect#
/mu#cle wea;ne## /weiht ain
I9I@-antiD
/h!"er#en#itivit! /hea$ache /renal failure
/nau#ea-vomitin
/alloimmune hemol!#i#
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"lenectom!
:#uall! re#erve$ for treatment failure
'on#i$er ri#; of lee$in, "t life#t!le
"I
*#urical "roce$ure
/lo## of immune function vaccination#
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Data from George, JN, Woolf, SH, Raso!, GE, et al. "loo#
$%%&' *.
)hen to $o "lenectom!7
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&e#"on#e Po#t"lenectom!
:#uall! normalie$ PT# within 2 wee;#
%often imme$iatel!*
Jouner "t# $o etter
Koouri et al %"loo# 200L* =3 '&
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Data from +a!ris, +, et al. "r J Haematol --$'
$$&*.
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'hronic &efractor! ITP
Per#i#tent E month#
PT N 30,000
ailure to re#"on$ to #"lenectom!
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)hen all el#e fail#<
teroi$# I9I - antiD
&itu5ima %anti'D20* '!clo"ho#"hami$e Danaol
Acce##or! #"lenectom! H. pylori era$ication
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)ra""in it u"<
ITP i# often a chronic $i#ea#e in a$ult#
Multi"le thera"ie# ma! e nee$e$ over
time @oal "revention of com"lication#
Thera"! nee$# to e tailore$ to the
in$ivi$ual "atient
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&eturn to Main
http://main%20presentation%203.12%20odac.ppt/http://main%20presentation%203.12%20odac.ppt/
