Immune thrombocytopenic purpura

Question 1

ITP on peripheral smear

Answer 1

Large platelets, no schistocytes

Question 2

Clinical course

Answer 2

VARIABLE: some do not require any treatment; others have a spontaneous remission or respond to first-line therapy with glucocorticoids; others continue to have severe thrombocytopenia necessitating additional therapy

Question 3

Physical exam

Answer 3

Normal

Question 4

Admission criteria per ASH

Answer 4

Platelet count <20K (ASH)

Question 5

Management

Answer 5

If severe bleeding → IVIG FIRST
IF bleeding or platelets <30,000/mm3 → decadron 40 mg x 4 days (preferred) or prednisone 0.5-2.0 mg/kg/day (ASH)
IF cutaneous symptoms AND platelets ≥30,000/mm3 → active surveillance

Question 6

Second line therapies for ITP

Answer 6

splenectomy, rituximab, or a thrombopoietin receptor agonist (TPO-RA) (no head to head studies)
IF surgical candidate → splenectomy + ensure immunizations
IF nonsurgical candidate → rituximab

Question 7

Steroid dosing for acute treatment

Answer 7

decadron 40 mg x 4 days (preferred over pred)

Question 8

Indications for treatment

Answer 8

1) bleeding

2) platelet count less than 30K

Question 9

Nplate generic name

Answer 9

romiplostim