Immune thrombocytopenia purpura

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). 

Patients with thrombocytopenia generally tolerate intravenous immunoglobulin well (35). In 16 young patients aged 9 months to 22 years with immune-mediated hemocytopenias (13 with childhood immune thrombocytopenic purpura), who received a total of 210 infusions, minimal adverse effects (transient headaches) were experienced during only four infusions, and later infusions were problem-free in three of the four patients (36). 

Hematologic A 3-year-old boy developed immune thrombocytopenic purpura 26 days after a second dose of seasonal influenza vaccine [12. He was given intravenous immunoglobulin and recovered within 2 days. A literature review showed that symptomatic thrombocytopenia occurs in a substantial number of children and adults who require hospitalization for complicated natural influenza infections. In contrast, reports of immune thrombocytopenic purpura after influenza immunization are rare and occur in adults. 

Hematologic The incidence of immune thrombocytopenic purpura after measles-mumps-rubella (MMR) immunization and the risk of recurrence after repeat immunization have been compared with the incidence after natural measles and rubella in a systematic review [19 ]. On the basis of 12 studies, the incidence of MMR-associated immune thrombocytopenic purpura was 0.087-4 (median 2.6) cases per 100000 vaccine doses. Severe bleeding was rare, and MMR-associated thrombocytopenia resolved within 6 months from diagnosis in 93% of cases. MMR vaccination of unimmunized patients with immune thrombocytopenic purpura and revaccination of patients with prior disease did not lead to recurrence. The authors concluded that MMR-associated immune thrombocytopenic purpura is rare, self-limiting, and non-life-threatening, and that susceptible children with immune thrombocytopenic purpura should be immunized with MMR at the recommended ages. 

Hematologic Drug-induced immune thrombocytopenia can occur after exposure to many medications and is sometimes indistinguishable from idiopathic thrombocytopenic purpura. When it is suspected. 

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). 

There is a relation between MMR vaccination and thrombocytopenic purpura, but not with the measles component itself (18). Thrombocytopenic purpura after MMR has been reviewed, with discussion of pathogenesis and the vaccines and infections associated with this problem (83). Rubella vaccine is one of the most frequently reported causes of thrombocytopenia in Denmark (84). In France, a retrospective epidemiological survey (1984-92) showed that the rates of thrombocytopenic purpura per 100 000 vaccinees were 0.23 for measles vaccine, 0.17 for rubella vaccine, 0.87 for combination MR vaccine, and 0.95 for MMR vaccine (85). Thrombocytopenia was severe and always associated with purpura. Cases of recurrent thrombocytopenic purpura after repeated MMR immunization have been reported (86,87). The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) has recommended avoiding subsequent doses of MMR when a previous episode of thrombocytopenia occurred in close temporal proximity to the previous immunization, that is within 6 weeks (88,89). 

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