From the Guidelines
Chronic Immune Thrombocytopenic Purpura (ITP) is defined as ITP duration of ≥12 mo, according to the 2019 American Society of Hematology guidelines. This definition is crucial in determining the management and treatment of patients with ITP, as the duration of the disease plays a significant role in deciding the appropriate course of action 1.
Key Characteristics of Chronic ITP
- ITP duration of ≥12 mo
- Abnormally low platelet counts
- Autoimmune condition where the immune system attacks and destroys platelets
- May impair platelet production in the bone marrow
- Patients may experience symptoms like easy bruising, petechiae, prolonged bleeding from cuts, spontaneous nosebleeds, or gum bleeding
Diagnosis and Treatment
The diagnosis of chronic ITP is based on the duration of the disease and the presence of low platelet counts. Treatment is typically initiated when platelet counts fall below 30,000/μL or if the patient experiences significant bleeding 1. The goal of treatment is to maintain safe platelet counts while minimizing treatment-related side effects.
Management Strategies
- First-line treatments: corticosteroids, intravenous immunoglobulin (IVIG), or anti-D immunoglobulin in Rh-positive patients
- Second-line options: thrombopoietin receptor agonists (eltrombopag, romiplostim), rituximab, or immunosuppressants
- Splenectomy may be considered in refractory cases
- Ongoing monitoring and long-term management strategies are necessary to maintain safe platelet counts and minimize treatment-related side effects 1.
From the Research
Definition of Chronic Immune Thrombocytopenic Purpura (ITP)
- Chronic Immune Thrombocytopenic Purpura (ITP) is an autoimmune disorder characterized by a low platelet count that has persisted for more than 12 months 2
- ITP is defined by a significantly reduced number of platelets in blood circulation, resulting in frequent bruising and bleeding 3
- It is an acquired autoimmune disorder characterized by the destruction of platelets and megakaryocytes, resulting in thrombocytopenia (platelet count <100 × 10⁹/L) 4
- ITP is isolated thrombocytopenia characterized by autoimmune-mediated disruption of platelet without other etiologies 5
- The disorder is associated with impaired thrombopoiesis and variations in immune response leading to platelet destruction during pathological conditions 3
Key Characteristics
- Low platelet count (<100 × 10⁹/L) 4
- Autoimmune-mediated disruption of platelet 5
- Impaired thrombopoiesis and variations in immune response leading to platelet destruction 3
- Dysfunction in primary haemostasis and loss of immune tolerance towards platelet as well as megakaryocyte antigens 3
Diagnosis and Treatment
- Diagnosis is based principally on the exclusion of other causes of isolated thrombocytopenia using patient history, physical examination, blood count, and evaluation of the peripheral blood film 4
- Treatment goals include resolving bleeding events and preventing severe bleeding episodes, with a target platelet count of >20-30 × 10⁹/L 4
- Current treatment options include corticosteroids, intravenous immunoglobulins, thrombopoietin receptor agonists, rituximab, and splenectomy 5, 4, 2, 6