Immune mediated thrombocytopenia ITP Flashcards
with suspected ITP who has platelets <30K should get
high dose steroids + platelet transfusion and IVIG
in pts who have ITP and platelet<20K despite steroids and platelet transfusion treatment
they often need rituximab or thrombopoetin recetpor agonists splenectomy,
mild ITP without bleeding
don’t need treatment
diagnosis of ITP is
diagnosis of exclusion. need to evaluate for other things first RARELY check auto antibodies for platelets.
what tests to order for a presumptive diagnosis of Immune thromocytopenic purpura
need history, physical exam, CBC with diff, examination of blood smear Need HIV and HCV- only if risk factors) treatment of these dx may alter course of secondary ITP Bone marrow aspiration is needed for pts who are >60 to rule out myelodysplastic syndrome
who should get a bone marrow biopsy/aspiration in the work up of random thrombocytopenia <30K
pts >60 to rule out myelodysplastic syndromes.
Treatment goals for ITP are:
to prevent major bleeding rather than normalizing the plalet count. Most pts will have a mild to moderate asymptomatic thrombocytopenia >30K and will have stable benign course pts with severe thrombocytopenia <30K are at risk for future bleeding and require initial tx with high dose oral steroids 1mg/kg even if they are asymptomatic
If pt has <30K and ITP what to do?
at risk for bleeding and so need to have high dose steroids 1mg/kg even if asymptomatic IVIG can be used if steroids alone is contraindicated. Can combine IVIG with steroids which will rapidly increase platelet count
Who gets splenectomy with ITP?
people who have refractory steroid dx or who require ongoing corticosteroids to maintain adequate platelet count. Rituximab is alternate for people who are poor surgical candidates or those who refuse surgery.
When do we use thrombopoiesis stimulating agents (force the bone marrow to make platelets)?
3rd line tx for people who get splenectomy and still refractory use agents like romiplostim or eltrombopag
Algorithm for tx of ITP
should pts with ITP also get ANA checked?
40% will have positive ANA but small amount will develop SLE. So don’t screen for ANA with ITP because it is not clinically relevant.
if there is thrombocytopenia need to rule out
HIV - 10% of HIV pts have thrombocytopenia as initial presenting sympotm
40% of HIV pts will have thrombocytopenia in disease course.
HCV/HBV screening only if necessary or has risk factors
If age >60 can get a bone marrow biopsy to rule out myelodysplastic syndromes.
