Chronic idiopathic thrombocytopenic purpura

Cortellazo S, Finazzi G, Buelli M, et al. High risk of severe bleeding in aged patients with chronic idiopathic thrombocytopenic purpura. Blood 1991 77 31-33. 

In a group of six children with acute thrombocytopenia and bone marrow megakaryocytic hyperplasia, the blood plasma, prepared as previously described, showed, in each case, an acid phosphatase activity, as determined by Gutman s method, that was higher than the mean value for that age (p = 0.02). The p value for the comparison of the group as a whole with normals was between 0.01 and 0.02. In all six of these patients the plasma acid phosphatase values returned to normal or near normal levels as the thrombocytopenia was corrected. Oski et al. (02) also studied 15 cases of chronic idiopathic thrombocytopenic purpura in whom the bone marrow showed normal to increased numbers of megakaryocytes. Of these, 13 showed plasma acid phosphatase values that were elevated above the normal mean for their age, albeit some of these differences were small. However, these elevations were statistically significant with a p value less than 0.01. 

Of 20 patients with chronic idiopathic thrombocytopenic purpura refractory to glucocorticoids or splenectomy treated with ciclosporin, six withdrew owing to toxicity (3). The target blood concentration range was identical to that aimed at in the first 3 months after kidney transplantation. The most common adverse effects were hypertension, headache, and severe myalgia. 

Kappers-Klunne MC, van t Veer MB. Cyclosporin A for the treatment of patients with chronic idiopathic thrombocytopenic purpura refractory to corticosteroids or splenectomy. Br J Haematol 2001 114(l) 121-5. 

Drachtman RA, Murphy S, Ettinger LJ. Exacerbation of chronic idiopathic thrombocytopenic purpura following measles-mumps-rubella immunization. Arch Pediatr Adolesc Med 1994 148(3) 326-7. 

Kimura F,Itoh H,Ambiru S,et al. (2002) Long-term results of initial and repeated partial splenic embolization for the treatment of chronic idiopathic thrombocytopenic purpura. AJR Am J Roentgenol 179 1323-1326... 

Whilst vincristine is normally mildly platelet suppressive, when it is used in such conditions as chronic idiopathic thrombocytopenic purpura, a rise in the platelet count may be seen. This thromhocythaemic effect has been suggested as a treatment for resistant cases of ITP (22). In these patients the effect has usually been to raise the platelets from a low value to within normal limits, but in most cases the platelets return to the previous lower levels in spite of the continued use of vincristine (22, 83). 

Ghosh, M. L. (1976) Long term effects of vincristine in chronic idiopathic thrombocytopenic purpura (ITP). J. Irish med. Ass., 69, 167. 

Hematologic diseases autoimmune hemolytic anemia, idiopathic thrombocytopenic purpura, pernicous anemia Kidney disease Goodpasture syndrom, lipoid nephroses, minimal change glomerulonephritis Diseases of the gastrointestinal tract autoimmune chronic active hepatitis, autoimmune atrophic gastritis, Crohn s disease, ulcerative colitis... 

Hematologic von Willebrand disease Idiopathic thrombocytopenic purpura Factor VII defect causing impaired platelet adhesion and increased bleeding time Decrease in circulating platelets—can be acute or chronic... 

McMillan, R., The pathogenesis of chronic immune (idiopathic) thrombocytopenic purpura. 

It is indicated in renal transplantation, severe active rheumatoid arthritis unresponsive to other therapy, certain autoimmune diseases, chronic active hepatitis, idiopathic thrombocytopenic purpura and acquired haemolytic anaemia. 

Idiopathic thrombocytopenic purpura, also referred to as immune thrombocytopenic purpura, is a bleeding disorder characterised by destruction of platelets. Antiplatelet autoantibodies are present, suggesting an autoimmune aetiology. These antibodies label the platelets for destruction by macrophages in the spleen. The condition may be acute or chronic. Acute ITP is the most common form and is found most often in children. Some cases are associated with recent viral infections and immunisations, notably the measles, mumps, rubella (MMR) vaccine. Typically, the disease is transient with no evidence of vaccine-associated recurrence. The peak incidence occurs between the ages of... 

Case study level 2 - Idiopathic thrombocytopenic purpura Case study level 3 - Chronic granulomatous disease 322 Case study level Ma - Chronic hepatitis B infection 324 Case study level Mb - Rheumatoid arthritis 325... 

IGIV is used either for andbody replacement or immuno-moduladon. Some of the incUcadons as replacement therapy include general or specific immunodeficiency states e.g., hepadds A prophylaxis, chronic lymphocydc leukemia with hypogammaglobulinemia, muldple myeloma with specific andbody deficiency, low birth weight babies at risk for infecdon and infants/children with HIV. It is also used as an immune modulator in concUdons such as idiopathic thrombocytopenic purpura and acquired hemophilia (Krensky et ah, 2005 Shah, 2005). 

Interferon alfa-induced immune-mediated thrombocytopenia shares many features with idiopathic thrombocytopenic purpuras and may be therefore coincidental (SED-13, 1094) (SEDA-20, 328) (SEDA-21, 371), but recurrence of thrombocytopenia on interferon alfa readministration strongly supports a causal role of interferon alfa (232). Cross reaction with interferon beta was not found in an isolated report (SEDA-20, 329). Even though severe and even fatal worsening of idiopathic thrombocjdopenic purpura has been observed after administration of interferon alfa (SED-13, 1094) (SEDA-20, 328), interferon alfa was not considered harmful in patients with chronic hepatitis C who were previously positive for platelet-associated immunoglobulin G (233). 

Immunodeficiency syndrome, idiopathic thrombocytopenic purpura, B-cell chronic lymphocytic leukemia (Gammagard SD,... 

Thrombotic thrombocytopenic purpura (TTP) is a severe systemic disorder characterized by the thrombi formation within the circulation that result in the platelet consumption and subsequent thrombocytopenia. The inherited sub-type is chronic and relapsing and generally occurs in childhood. Acute idiopathic TTP, which occurs in adults, is more common and harder to treat. The estimated annual incidence of TTP is 3.7 cases per million.33... 

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