scholarly journals Low platelet count as risk factor for infections in patients with primary immune thrombocytopenia: a retrospective evaluation

2018 ◽  
Vol 97 (9) ◽  
pp. 1701-1706 ◽  
Author(s):  
Mingming Qu ◽  
Qiang Liu ◽  
Hong-Guo Zhao ◽  
Jun Peng ◽  
Heyu Ni ◽  
...  
Keyword(s):  
Risk Factor ◽  
Platelet Count ◽  
Immune Thrombocytopenia ◽  
Retrospective Evaluation ◽  
Primary Immune Thrombocytopenia ◽  
Low Platelet Count

Quality of Life Improvements Following Eltrombopag Treatment in Children with Chronic Immune Thrombocytopenia: Case Report

2021 ◽  
Vol 104 (4) ◽  
pp. 672-675
Keyword(s):  
Quality Of Life ◽  
Platelet Count ◽  
Receptor Agonist ◽  
Immune Thrombocytopenia ◽  
Case Series ◽  
Thrombopoietin Receptor ◽  
Thrombopoietin Receptor Agonist ◽  
Low Platelet Count ◽  
Chronic Immune Thrombocytopenia

The present case series described six chronic immune thrombocytopenia patients (cITP), with a median age of 7.7 (7.0 to 13.0) years and low platelet count at 15,500 (7,000 to 20,000)/uL. They were suffering from bleeding symptoms and side effects of treatment. After enrollment, they were treated with thrombopoietin receptor agonist (eltrombopag). Five patients responded positively, showing a median platelet count of 115,000 (39,000 to 433,000)/uL. The median dose of eltrombopag used was 1.3 (0.8 to 2.2) mg/kg/day. The quality of life (QoL) improved for all patients, with their median overall score using a Pediatric QoL questionnaire showing 25.0% improvement. Median scores also showed improvements in each sphere of life functioning as physical (30.8%), emotional (26.4%), social (16.4%), and school (21.4%). The present report demonstrated that a select group of cITP patients, with low platelet count and bleeding symptoms, benefitted from treatment with eltrombopag, as shown by increased platelet counts and improved QoL. Keywords: Chronic ITP, Thrombopoietin receptor agonist, Children

How I Manage cyclic thrombocytopenia

Blood ◽  
2020 ◽  
Author(s):  
Paul A Kyrle ◽  
Sabine Eichinger
Keyword(s):  
Platelet Count ◽  
Immune Thrombocytopenia ◽  
Hematological Malignancies ◽  
Severe Bleeding ◽  
Typical Pattern ◽  
Periodic Fluctuation ◽  
Thrombopoietin Receptor ◽  
Primary Immune Thrombocytopenia ◽  
Platelet Count Monitoring ◽  
Mucocutaneous Bleeding

Cyclic thrombocytopenia (CTP) is a rare disease, which is characterized by periodic fluctuation of the platelet count. The pathogenesis of CTP is unknown and most likely heterogeneous. Patients with CTP are almost always misdiagnosed as having primary immune thrombocytopenia (ITP). The interval between ITP and CTP diagnosis can be many years. CTP patients often receive ITP-specific therapies including corticosteroids, thrombopoietin receptor agonists, rituximab and splenectomy which are followed by a transient increase in platelet count that is wrongly attributed to treatment effect with inevitable "relapse". CTP can be diagnosed by frequent platelet count monitoring which reveals a typical pattern of periodic platelet cycling. An early diagnosis of CTP will prevent these patients from being exposed to possibly harmful therapies. The bleeding phenotype is usually mild and consists of mucocutaneous bleeding at the time when the platelet count is at its nadir. Severe bleeding from other sites can occur but is rare. Some patients respond to cyclosporine A or to danazol, but most patients do not respond to any therapy. CTP can be associated with hematological malignancies or disorders of the thyroid gland. Nevertheless, spontaneous remissions can occur, even after many years.

scholarly journals Maternal and fetal outcomes of primary immune thrombocytopenia during pregnancy: A retrospective study

2017 ◽  
Vol 11 (1) ◽  
pp. 12-16 ◽  
Author(s):  
KS Gilmore ◽  
C McLintock
Keyword(s):  
Platelet Count ◽  
Immune Thrombocytopenia ◽  
Post Partum ◽  
Bleeding Complications ◽  
Platelet Response ◽  
Thrombocytopenic Purpura ◽  
Primary Immune Thrombocytopenia ◽  
Secondary Outcomes ◽  
Post Partum Haemorrhage ◽  
Auckland Hospital

Objective We reviewed outcomes of 52 pregnancies in 45 women with immune thrombocytopenic purpura who delivered at Auckland Hospital with an antenatal platelet count of <100 × 109/L. Outcome measures Primary outcomes were maternal platelet count at delivery and treatment response. Secondary outcomes included post-partum haemorrhage (PPH). Results Most women had thrombocytopenia at delivery. Treatment with prednisone was given in 14 (27%) pregnancies with responses considered safe for delivery in 11 pregnancies (79%). Women in eight pregnancies also received intravenous immunoglobulin; in five pregnancies (63%) a platelet response acceptable for delivery was achieved. Seventeen pregnancies (33%) were complicated by a PPH ≥500 mL. Ten pregnancies (19%) were complicated by a PPH ≥1000 mL. PPH was reported in all women with a platelet count <50 × 109/L at delivery. Conclusions There were no antenatal bleeding complications but PPH was common among women with platelet counts <50 × 109/L at the time of birth.

scholarly journals Analysis of Interleukin-4 in Thrombocytopenia Autoimmune Patients

Biomedika ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 131-135
Author(s):  
Sitti Nurfaizah ◽  
Mansyur Arief ◽  
Uleng Bahrun
Keyword(s):  
Platelet Count ◽  
Medical Records ◽  
Immune Thrombocytopenia ◽  
Interleukin 4 ◽  
Subject Group ◽  
Elisa Method ◽  
Platelet Production ◽  
Cytokine Levels ◽  
Primary Immune Thrombocytopenia ◽  
Loss Of Tolerance

Thrombocytopenia is a disease characterized by a decreased platelet count. Some of the causes are decreased platelet production, increased platelet use, such as due to infection, and autoimmune causes, namely the loss of tolerance of the immune system to self-antigens on the surface of the platelets and megakaryocytes marked with a platelet count <100,000 / μL and based on the pathomechanism classified as primary Immune Thrombocytopenia (ITP) and secondary, as well as several other causes. IL-4, one of the cytokines produced by Th2 which stimulates B cells to increase antibody production. The aim of this study was to compare IL-4 levels in primary ITP patients and non-primary ITP tombocytopenia. This study involved 30 primary ITP subjects and 30 non-ITP primary tombocytopenia subjects obtained based on data medical records, examination of IL-4 cytokine levels by the ELISA method. The results of this study that the IL-4 levels of the primary non ITP tombocytopenia subject group were higher than the primary ITP subject group, which means that there were differences in IL-4 levels in the primary ITP subject group and the non-ITP primary tombocytopenia subject group.

scholarly journals Interleukin (IL)-1 family cytokine in primary immune thrombocytopenia: a comparison with systemic lupus erythematosus-associated thrombocytopenia

2020 ◽  
Author(s):  
Yanxia Zhan ◽  
Boting Wu ◽  
Chanjuan liu ◽  
Luya Cheng ◽  
Lili Ji ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Platelet Count ◽  
Lupus Erythematosus ◽  
Immune Thrombocytopenia ◽  
Serum Levels ◽  
Healthy Controls ◽  
Systemic Lupus ◽  
Primary Immune Thrombocytopenia ◽  
Polymerase Chain

Abstract Background : Primary immune thrombocytopenia (ITP) is an autoimmune-mediated disorder characterized by decreased platelet count. Systemic lupus erythematosus (SLE) is also an autoimmune disease which thrombocytopenia is a common hematologic manifestation. Interleukin (IL)-1 family cytokines are major proinflammatory and immunoregulatory mediators. This study aimed to investigate the role of IL-1 cytokines in patients with ITP and SLE and the potential pathophysiologic mechanism to differentiate SLE-associated thrombocytopenia (SLE-TP) from ITP. Methods : Multiplex cytokine assay and real-time polymerase chain reaction (RT-PCR) were used to measure the IL-1 cytokines in 17 newly diagnosed ITP patients, 17 SLE-TP patients, 19 SLE patients without thrombocytopenia (SLE-NTP) and 10 healthy controls. Results : The serum levels of IL-1β, IL-18, IL-36α, IL-36β, IL-36γ and IL-33 were decreased significantly in ITP patients as compared with SLE-TP, SLE-NTP patients and healthy controls ( p <0.05). There was no significantly difference in the serum level of IL-37 between ITP and SLE-TP patients, however, there is a positive correlation between platelet count with IL-37 level in ITP patients. Our data suggested that serum IL-1β, IL-18, IL-36α, IL-36β, IL-36γ, IL-33 and IL-37 were involved in the pathogenesis of ITP. Conclusions : Serum IL-1β, IL-18, IL-36α, IL-36β, IL-36γ and IL-33 could be considered biomarkers to differentiate SLE-TP from ITP patients.

Severe Thrombocytopenia Delays but Does Not Prevent the Occlusion of an Arterial Prosthesis in Rats

1981 ◽  
Vol 46 (02) ◽  
pp. 558-560 ◽  
Author(s):  
I Reyers ◽  
L Mussoni ◽  
M B Donati ◽  
G de Gaetano
Keyword(s):  
Platelet Count ◽  
Abdominal Aorta ◽  
Immune Thrombocytopenia ◽  
Severe Thrombocytopenia ◽  
Thrombotic Occlusion ◽  
Arterial Prosthesis ◽  
Low Platelet Count ◽  
Experimentally Induced

SummaryThis study shows that experimentally-induced immune thrombocytopenia significantly delayed occlusion of an arterial prosthesis inserted in rat abdominal aorta. Thrombocytopenia was effective when induced several hours or shortly, or even several hours after the insertion of the prosthesis. Maintenance of severe thrombocytopenia by daily administrations of antiplatelet antiserum appeared to further delay thrombotic occlusion.However, though delayed, occlusion eventually occurred in all rats, even in those with very low platelet count. This would imply that any attempt to prevent arterial prosthesis thrombosis solely by interfering with platelets is ultimately bound to fail.

scholarly journals Multiple concomitant mechanisms contribute to low platelet count in patients with immune thrombocytopenia

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Matías Grodzielski ◽  
Nora P. Goette ◽  
Ana C. Glembotsky ◽  
M. Constanza Baroni Pietto ◽  
Santiago P. Méndez-Huergo ◽  
...  
Keyword(s):  
Platelet Count ◽  
Immune Thrombocytopenia ◽  
Low Platelet Count

Increased Microparticle-Linked Procoagulant Activity In Patients with Primary Immune Thrombocytopenia.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3707-3707
Author(s):  
Elena G. Arias Salgado ◽  
Ihosvany Fernández Bello ◽  
Mayte Álvarez Román ◽  
Isabel Rivas ◽  
Mónica Martín Salces ◽  
...  
Keyword(s):  
Platelet Count ◽  
Immune Thrombocytopenia ◽  
Thrombin Generation ◽  
Conflicts Of Interest ◽  
Lag Time ◽  
Peak Height ◽  
Procoagulant Activity ◽  
Control Group ◽  
Increased Risk ◽  
Primary Immune Thrombocytopenia

Abstract Abstract 3707 Primary immune thrombocytopenia (ITP) is an acquired immune-mediated disorder characterized by isolated thrombocytopenia (platelet count less than 100,000/μL) and the absence of any obvious initiating and/or underlying cause for the thrombocytopenia. In spite of the low platelet number, some thrombocytopenic patients seldom bleed, indicating the existence of other factors that regulate haemostasis in these patients. Elevated levels of plasma microparticles (MPs) had been observed in IPT patients. MPs are vesicles with a size less than 0.5 micrometers, derived from cell membranes after their activation or apoptosis. Most MPs are highly procoagulant, expressing annexin V binding sites and tissue factor. However, relatively little is known of their specific functions in ITP. In the present study we aim to elucidate if a relationship exists between microparticle-linked procoagulant activity and haemostasis in ITP patients. Twenty-two ITP patients, 3 male and 19 female, aged between 25 to 92 years, were included. Sixteen age- and sex-matched healthy individuals were used as control group. Platelet-related primary haemostasis was evaluated with an automated platelet function analyzer (PFA-100®, Siemens Healthcare Diagnostics). Samples of citrated blood were aspirated under a shear rate of 4,000–5,000/s through a 150-micrometer aperture cut into a collagen-ADP (COL-ADP) or collagen-epinephrine (COL-EPI) coated membrane. The platelet haemostatic capacity is indicated by the time required for the platelet plug to occlude the aperture (closure time), which is expressed in seconds. MP procoagulant activity was determined with ZYMUPHEN MP-Activity kit (Aniara, Mason, Ohio) and by calibrated automated thrombography (CAT) in plasma samples obtained after 2 centrifugations at room temperature (first: 15 min at 1,500 g, second: 2 min at 13,000 g). These methods measure endogenous thrombin generation. CAT evaluates four parameters of thrombin generation: the endogenous thrombin potential (ETP), lag time, time to peak (TTP) and peak height. PFA-100® determinations with COL-EPI and COL-ADP cartridges in blood samples from ITP patients with less than 50,000/μL showed longer closure times than control group (p<0.05), whereas samples from ITP patients with a platelet count between 50,000/μL and 100,000/μL showed closure times of the same order of magnitude as control ones (platelet count ranging from 162,000 to 368,000)μL).Plasma from these patients had higher MP-mediated procoagulant activity evaluated with ZYMUPHEN kit (control 6.1+3.9 nM, ITP group 10,1±8.2 nM, p<0.05) as well as with CAT (ETP (nM*min): control: 1692.6±341.9, ITP: 2191,8±398.9, p<0.01; lag time (min): control: 19.9±8.2, ITP: 14.3±4.3, p<0.05; TTP (min): control: 22.0±8.3, ITP:16.3±4.4, p<0.05; peak height (nM): control: 389.7±70.6, ITP: 498,8±97.5, p<0.01). Our results indicate that increased MP procoagulant activity in ITP patients may be protective against bleeding events that should be observed in those thrombocytopenic conditions. Three of the ITP patients included in this study had been splenectomyced and we consider of interest to point out that two of them in spite of recovering a normal platelet count still maintain a high MP procoagulant activity. This observation agrees with a recent work that postulates that MPs might contribute to an increased risk of thrombosis, progression of atherosclerosis and cardiovascular disease following splenectomy (Fontana et al, Thromb Research, 2008;122:59). Disclosures: No relevant conflicts of interest to declare.

scholarly journals Laparoscopic splenectomy for immune thrombocytopenia in patients with a very low platelet count

2018 ◽  
Vol 13 (2) ◽  
pp. 157-163 ◽  
Author(s):  
Anna Zychowicz ◽  
Dorota Radkowiak ◽  
Anna Lasek ◽  
Piotr Małczak ◽  
Jan Witowski ◽  
...  
Keyword(s):  
Platelet Count ◽  
Laparoscopic Splenectomy ◽  
Immune Thrombocytopenia ◽  
Low Platelet Count

Dexamethasone plus rituximab yields higher sustained response rates than dexamethasone monotherapy in adults with primary immune thrombocytopenia

Blood ◽  
2010 ◽  
Vol 115 (14) ◽  
pp. 2755-2762 ◽  
Author(s):  
Francesco Zaja ◽  
Michele Baccarani ◽  
Patrizio Mazza ◽  
Monica Bocchia ◽  
Luigi Gugliotta ◽  
...  
Keyword(s):  
Platelet Count ◽  
Adverse Events ◽  
Salvage Therapy ◽  
Immune Thrombocytopenia ◽  
Sustained Response ◽  
Effective Treatment Option ◽  
Serious Adverse Events ◽  
Primary Immune Thrombocytopenia ◽  
Grade 3 ◽  
To Receive

Abstract Previous observational studies suggest that rituximab may be useful in the treatment of primary immune thrombocytopenia (ITP). This randomized trial investigated rituximab efficacy in previously untreated adult ITP patients with a platelet count of 20 × 109/L or less. One hundred three patients were randomly assigned to receive 40 mg/d dexamethasone for 4 days with or without 375 mg/m2 rituximab weekly for 4 weeks. Patients who were refractory to dexamethasone alone received salvage therapy with dexamethasone plus rituximab. Sustained response (ie, platelet count ≥ 50 × 109/L at month 6 after treatment initiation), evaluable in 101 patients, was greater in patients treated with dexamethasone plus rituximab (n = 49) than in those treated with dexamethasone alone (n = 52; 63% vs 36%, P = .004, 95% confidence interval [95% CI], 0.079-0.455). Patients in the experimental arm showed increased incidences of grade 3 to 4 adverse events (10% vs 2%, P = .082, 95% CI, −0.010 to 0.175), but incidences of serious adverse events were similar in both arms (6% vs 2%, P = .284, 95% CI, −0.035 to 0.119). Dexamethasone plus rituximab was an effective salvage therapy in 56% of patients refractory to dexamethasone. The combination of dexamethasone and rituximab improved platelet counts compared with dexamethasone alone. Thus, combination therapy may represent an effective treatment option before splenectomy. This study is registered at http://clinicaltrials.gov as NCT00770562.

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