Induction of the remission of immune thrombocytopenic purpura

2020 ◽  
Vol 22 (3) ◽  
pp. 93-98
Author(s):  
V. I. Odin ◽  
N. P. Lehthlaan-Thynisson ◽  
A. D. Zolotarev ◽  
N. V. Mineeva ◽  
A. S. Polyakov
Keyword(s):  
Young Patient ◽  
Immune Thrombocytopenic Purpura ◽  
Spontaneous Remission ◽  
Thrombocytopenic Purpura ◽  
Standard Drug ◽  
Fatal Bleeding ◽  
Wave Technique ◽  
Acute Form ◽  
Activation Therapy

Abstract. A review of the literature on remission of immune thrombocytopenic purpura in children and a retrospective analysis of its course in a young patient who was successively applied, first to no avail, standard drug therapy, and then, due to the lack of effect, a physiotherapy technique based on the principles of activation therapy. It is known that immune thrombocytopenic purpura is a rare acquired autoimmune disease characterized by isolated thrombocytopenia with the occurrence of hemorrhagic syndrome of varying severity, which can lead to fatal bleeding. At the same time, antiplatelet antibodies are detected only in half of patients suffering from immune thrombocytopenic purpura, and therefore are not a necessary criterion for diagnosis, which in turn makes it difficult to diagnose the disease and does not allow them to be used as a criterion for the effectiveness of treatment. Despite the fact that in childhood, most cases of immune thrombocytopenic purpura occur in acute form, often with the development of spontaneous remission, but in a significant part of patients, relapses of the disease are accompanied by significant thrombocytopenia, hemorrhagic syndrome, and a decrease in the quality of life, which requires specific therapy up to splenectomy. When using the Reverse wave technique in the treatment of immune thrombocytopenic purpura, a stable, long-term remission was achieved in a young patient. The prospects of studying the application of this physiotherapy technique in clinical practice are discussed.

Safety and Efficacy of Laparoscopic Splenectomy in Patients with Refractory Immune Thrombocytopenic Purpura. A Long-Term Survey

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4548-4548
Author(s):  
Nicola Cascavilla ◽  
Matteo Scaramuzzi ◽  
Michele Nobile ◽  
Matteo Dell’Olio ◽  
Antonietta Pia Falcone ◽  
...  
Keyword(s):  
Platelet Count ◽  
Immune Thrombocytopenic Purpura ◽  
Laparoscopic Splenectomy ◽  
New Drugs ◽  
Thrombocytopenic Purpura ◽  
Safety And Efficacy ◽  
Haematological Response ◽  
Short And Long Term

Abstract Background: Despite the popularity of splenectomy has decreased dramatically in the past few years, the surgical approach remains the best therapy for patients with refractory Immune Thrombocytopenic Purpura (ITP) in terms of high and durable rate of response (Vesely et al, Ann Intern Med2004; 140: 112). The recent introduction of anti-CD20 antibodies and thrombopoietins of second generation such as AMG 531 and Eltrombopag may have a relevant role (Kuter et al, Lancet2008; 371: 362) but their long-term safety and efficacy have not been still established. In parallel with new drugs, there has been an evolution in the surgery of splenectomy as well (Dolan et al, Am J Hematol2008; 83: 93). Actually, the laparoscopic surgery is considered the standard approach and the ITP represents the most common indication in 50–80% of all the laparoscopic splenectomies. Methods: The aim of this study is to evaluate the long-term complete and partial haematological response (CR + PR), as well as the short and long-term complications, of 40 patients (30 females and 10 males; median age: 38 years - range 6–71) with unresponsive ITP after one or more medical approaches and underwent laparoscopic splenectomy at our Institution from 1999 through 2006. The 40 patients accounted for 22.2% of 181 patients diagnosed in those years. An abdominal CT scan to evaluate the presence of accessory spleens was performed in all cases. All patients received meningococcal, pneumococcal and haemophilus influenzae vaccine one week before splenectomy. For 4 or 5 days before splenectomy the patients were treated with high doses of intravenous Immunoglobulins. Anti-thrombotic prophylaxis was performed with low molecular weight heparin (LMWH) for 10 days and afterwards with cardioaspirin (ASA) if the platelet count exceeded 500x10E9/L. Results: No cases required conversion to laparotomic splenectomy. An accessory spleen was found in 2 patients (5%). Immediate haematological response rate was of 100%. At date, after a median follow-up of 78 months (range 28–112 months), 36 patients (90%) remain in CR or PR with a platelet count more than 50x10E9/L and 2 patients are taking ASA. Four patients (10%) relapsed; out of which, 2 patients have a platelet count less than 10x10E9/L. Short and long-term mortality rate was 0%. Immediate postoperative complications rate was 5%: we observed 2 cases of hemoperitoneum related to a trocar’s tube and to an active bleeding, respectively, both resolved with new laparoscopic approach. The mean postoperative hospital stay was 4,5 days (range 4–8). Neither cases of bacterial sepsis in the postoperative or during the follow-up time, nor cases of splenic-portal vein thrombosis (SPVT) and no cases of neoplasms occurred. Conclusions: Our experience suggests that laparoscopic splenectomy is an excellent approach to patients with refractory ITP in terms of safety, efficacy and costs. With respect to laparotomic splenectomy, the use of laparoscopy is likely to make the splenectomy even safer and therefore suitable for a larger number of patients. Undoubtedly there is a great expectation for the new drugs (Rodeghiero et al, Am J Hematol2008; 83: 91) and we agree that only controlled comparative clinical trials (Vianelli et al, Haematologica2005; 90: 72) will be able or not to say a final word and to challenge the role of splenectomy.

Response to Anti D immunoglobulin in Adults with Chronic Immune Thrombocytopenic Purpura in a Minority Cohort with Long Term Follow up.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4465-4465
Author(s):  
Shylendra B Sreenivasappa ◽  
Tareq Braik ◽  
Sonia Sandhu ◽  
Barbara Yim ◽  
Rosalind Catchatourian
Keyword(s):  
Blood Group ◽  
Immune Thrombocytopenic Purpura ◽  
Univariate Analysis ◽  
Poor Response ◽  
Complete Response ◽  
Median Number ◽  
Time To Progression ◽  
Thrombocytopenic Purpura ◽  
Time To Relapse

Abstract Abstract 4465 Background Immune Thrombocytopenic Purpura (ITP) is a common hematological disorder. We sort to characterize the risk profiles and efficacy of anti D immunoglobulin in chronic ITP in a largely minority cohort. Methods 31 patients (pts) with chronic immune thrombocytopenic purpura treated 2003-2008 were studied as a retrospective cohort for clinical presentation, prognostic characteristics, time to next therapy and long term survival. Prognostic factors, time to relapse and overall survival was analyzed using fisher's exact test, logistic regression, Kaplan Meier survival analysis and Cox Proportional Hazards model. Results 31 pts 19(61.3%) female and 12(38.7%) male. 11 (35.5%) African Americans, 12(38.7%) Hispanic, 5 (16.2%) Asians and 3 (7.8%) Caucasians. Median age at diagnosis was 44 yrs (21-66). 25 (80.5%) were HIV negative and 6 (19.5%) had HIV. 16 (51.6%) had O positive blood group, 9 (29.6%) had A positive and 4 (12.9%) had B positive. The median number of co-morbidities at diagnosis was 1(0-6). Median age at which anti D immunoglobulin was initiated was 45 yrs. Pt had received a median of 3 (2-6) therapies prior to anti D therapy. All patients had received steroids, 17 (54.8%) had immunoglobulin therapy, 2 (6.5%) had vincristine and 6(19.3%) had splenectomy prior to anti D therapy. The median duration to anti D therapy was 6 months (0-228). Anti D therapy was given in the dose of 50-75mcg/kg IV weekly. Median number of doses given was 2 (1-7) doses. The response rate was 64.5%. Response was defined as Complete response, platelet count of > 100 × 109/L, Partial response >30 × 109/L. 17 (54.8%) achieved complete response, 3 (9.7%) achieved partial response. 11(35.5%) did not respond. Median time to relapse was 4 months (0-79). 9 (29%) achieved a complete response for over a year. Pt with HIV (p=0.013), O blood group (p=0.030) had a significant poor response to anti D therapy on univariate analysis. Pt with HIV (p=0.035) had poor response to therapy on multivariate analysis. O blood group (p=0.001), HIV (p=0.016), > 2 lines of therapy (p=0.007), one dose of anti D (0.037) were associated with shorter time to progression on univariate analysis. On multivariate analysis prior immunoglobulin administration (p=0.039), >2 lines of therapy (p=0.004) and single dose of anti D immunoglobulin (p=0.039) were associated with shorter time to progression. Conclusion Anti D immunoglobulin had a response rate of 64.5% which is similar to other studies. About 29% of patients had a complete response for over a year. Pts who not received anti D immunoglobulin, HIV negative and early anti D administration had the best response and longer time to progression. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Two Cases and Review of the Literature: Primary Percutaneous Angiography and Antiplatelet Management in Patients with Immune Thrombocytopenic Purpura

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Estelle Torbey ◽  
Harout Yacoub ◽  
Donald McCord ◽  
James Lafferty
Keyword(s):  
Antiplatelet Therapy ◽  
Immune Thrombocytopenic Purpura ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Review Of The Literature ◽  
Thrombocytopenic Purpura ◽  
Coronary Syndrome ◽  
First Case ◽  
St Elevation

We report two cases of immune thrombocytopenic purpura (ITP) associated with acute coronary artery syndrome highlighting the interventions done in every case along with the medications used during intervention and as outpatient. The first case is that of a woman with ITP exacerbation while on dual antiplatelet therapy and the second case is that of a male presenting with non-ST elevation myocardial infarction (NSTEMI) while in a thrombocytopenic crisis. In both cases antiplatelet therapy was held and thrombopoietic therapy was initiated before resuming full anticoagulation and coronary intervention. Given the paucity of data on ITP and antiplatelets treatment in the setting of acute coronary syndrome, no strict recommendations can be proposed, but antiplatelets appear to be safe acutely and in the long term in this category of patients as long as few measures are undertaken to minimize the risks of bleeding and thrombosis.

scholarly journals Long-term outcome of splenectomy for immune thrombocytopenic purpura

2004 ◽  
Vol 75 (2) ◽  
pp. 117-118 ◽  
Author(s):  
K. Ma?lanka ◽  
A. Sikorska ◽  
A. Misiak ◽  
L. Konopka ◽  
B. ?upa?ska
Keyword(s):  
Immune Thrombocytopenic Purpura ◽  
Term Outcome ◽  
Thrombocytopenic Purpura ◽  
Long Term Outcome
Sign in / Sign up

Export Citation Format

Share Document