Chronic immune thrombocytopenia

Fujisawa, K., Tani, P, and McMillan, R., Platelet-associated antibody to glycoprotein llb/Illa from chronic immune thrombocytopenia purpura patients often binds to divalent cation-dependent antigens. Blood l, 1284-1289 (1993). 

Romiplostim, declared an orphan drug by the FDA in 2003, is an Fc fusion protein analogue of thrombopoietin and a thrombopoietin receptor agonist. The drug increases the number of platelets and restores platelet function making it a candidate for the treatment of chronic immune thrombocytopenia where a reported side-effect is its involvement in cases of stent thrombosis [68 ]. 

Hegde UP, Wilson WH, White T, Cheson BD. Rituximab treatment of refractory fludarabine-associated immune thrombocytopenia in chronic lymphocytic leukemia. Blood 2002 100(6) 2260-2. 

Zaja, R, lacona, L, Masolini, P, Russo, D., Sperotto, A., Prosdocimo, S., Patriarca, R, de Vita, S., Regazzi, M., Baccarani, M., and Panin, R., B-cell depletion with rituximab as treatment for immune hemolytic anemia and chronic thrombocytopenia, Haematologica, 87, 189-195, 2002. 

Management may on occasions have to be splenectomy but in these situations there are generally other factors. For example, in chronic lymphocytic leukaemia contributions to the thrombocytopenia that occurs from reduced production of the one hand and rapid clearance due to immune mechanisms on the other. 

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). 

Thrombocytopenia is a relatively common feature in both acute and chronic liver disease and is proportional to the extent of liver disease. The etiology of thrombocytopenia in liver disease is multifactorial, but involves primarily hypersplenism with pooling of platelets, immune-mediated destruction, and the inability of the bone marrow to compensate for the accelerated removal. The bone marrow depression may be related to alcohol, drugs, and nutritional deficiencies associated with the cirrhotic process. ... 

---