ITP facts Flashcards
M:F in ITP
Females of child baring age
M:F 1:1 for age 60
Serious bleeding in ITP
5-6%
Anti-GP ab in ITP
Specific but not sensitive
Good for confirmation, but can not distinguish primary and secondary
Phases of ITP
< 3 months - newly diagnosed
3-12 months- persistent
>12 months- chronic
Occult cerebral microbleeds in ITP %
50%
in pts with PLT<30
Rituximab addition in 1st line in ITP
Better sustained response rates
But there is no benefit in ORR in 1 year
Not recommended
2nd line options for ITP
Rituximab
TPO-RA
Fosfamatinib
3rd line option for ITP
Fostamatinib
Splenectomy
Persistent/Chronic ITP %
60-70%
TPO-RA ORR in ITP
85%
Rituximab ORR in ITP
60-70%
Achieved after 4-8 weeks
Most will relapse after 6 months
Fostamatinib ORR in ITP
40%
with durable response
Splenectomy in ITP ORR
60-70%
long term durable response rates
usually 3rd/4th line
at least 12-24 months after diagnosis
Novel therapies in ITP
Rozanolixizumab (anti FcRn)
Efgartigimod (anti FcRn)
Sutimlimab (anti c1)
BTKi
Platelet counts for delivery
50K vaginal
70k CS
80K for epidural anesthesia
Tx options for pregnant ITP pts
Prednisone
IVIG
rhTPo (available in china)
Azathioprine
Cyclosporine A
Rituximab maybe safe
Response/Remission on steroids in ITP
75% Response
but only 20-30% long term remisssion
Steroid length of Tx in ITP
Taper in order to stop by 6-8 weeks
Rituximab subpopulation effectiveness in ITP
younger females with short disease duration
Avatrombopag advantage over eltrombopag in ITP
No food interactions
No need for liver enzyme follow up
TPO-RA switch effectiveness in ITP
50-80%
Remission of ITP after TPO-RA discontinuation
10-30%
Durable response rates of 2nd line Tx in ITP
TPO-RA- 65%
Rituximab 40%
Fostamatinib 20%
Upshaw-Schulman syndrome
Hereditary TTP
Can be diagnosed in adults
Tx with recombinant ADAMTS13
