Materiały źródłowe

• #1 Immune Thrombocytopenia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562282/

  Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by a low platelet count, purpura, and hemorrhagic episodes. […] The diagnosis is typically made by excluding known thrombocytopenia causes. […] The American Society of Hematology (ASH) defines ITP as a generalized purpuric rash accompanied by a platelet count less than 100,000/L and normal white blood cell (WBC) count and hemoglobin level. […] Initial laboratory evaluation for children and adults should include a complete blood count (CBC) with differential WBC count, reticulocyte count, and peripheral blood smear (PBS). […] The WBC count, hemoglobin concentration, red cell indices, and leukocyte differential are usually normal in patients with ITP. However, the platelet count is characteristically less than 100,000/L.

• #2 How we treat primary immune thrombocytopenia in adults | Journal of Hematology & Oncology | Full Text

  https://jhoonline.biomedcentral.com/articles/10.1186/s13045-023-01401-z

  Primary immune thrombocytopenia (ITP) is an immune-mediated bleeding disorder characterized by decreased platelet counts and an increased risk of bleeding. […] The diagnosis remains a clinical exclusion of other causes of thrombocytopenia. […] The international working group (IWG) on ITP and the American Society of Hematology (ASH) both updated their guidelines for the diagnosis and management of ITP in 2019. […] Therefore, the diagnosis of ITP can be established with careful history taking and physical examination, as well as a review of peripheral blood smears and minimal further testing in most patients. […] However, the application of this diagnostic criterion will lead to misdiagnosis in a small proportion of patients with suspected ITP. […] To minimize the misdiagnosis rate, the Chinese ITP guidelines also recommend bone marrow examination and tests for antinuclear antibodies (ANAs), anti-phospholipid antibodies (APLAs), anti-thyroid antibodies, thyroid function, and coagulation parameters as the basic evaluation.

• #3

  https://journals.lww.com/bloodcoagulation/fulltext/2022/09000/primary_immune_thrombocytopenia__a__diagnosis_of.1.aspx

  Current diagnosis of primary immune thrombocytopenia (ITP) is presumptive, centered on excluding other causes of thrombocytopenia. […] The diagnosis of ITP is challenging because of the wide range of potential inherited and acquired causes of thrombocytopenia. […] We did not identify a diagnostic test that clinicians can use to confirm the diagnosis of ITP. […] In the absence of a diagnostic test of proven value in ITP, the clinician is best served by a comprehensive history and physical examination, complete blood count and review of the peripheral blood smear in evaluating thrombocytopenia. […] Devoid of a definitive confirmatory test, it is difficult to reliably establish the diagnosis without excluding congenital and acquired causes. […] Since the original description by Harrington and James W. Hollingsworth in 1950, there has been no significant advancement made in the diagnostic criteria, despite the fact that rapid strides have been made in the management of ITP.

• #4 Immune Thrombocytopenia (ITP): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/202158-overview

  Immune thrombocytopenia (ITP) is a syndrome in which platelets become coated with autoantibodies to platelet membrane antigens, resulting in splenic sequestration and phagocytosis by mononuclear macrophages. […] ITP is diagnosed by excluding other diseases; therefore, the absence of other findings from the peripheral smear is at least as important as the observed findings. […] No single laboratory result or clinical finding establishes a diagnosis of ITP; it is a diagnosis of exclusion. […] The value of bone marrow evaluation for a diagnosis of ITP is unresolved. […] In adults older than 60 years, biopsy is used to exclude myelodysplastic syndrome or leukemia. […] Unresponsiveness to standard treatment after 6 months is an indication for bone marrow aspiration.

• #5 Immune thrombocytopenia (ITP) in adults: Clinical manifestations and diagnosis – UpToDate

  https://www.uptodate.com/contents/immune-thrombocytopenia-itp-in-adults-clinical-manifestations-and-diagnosis

  Immune thrombocytopenia (ITP, also called idiopathic thrombocytopenic purpura, immune thrombocytopenic purpura) is an acquired thrombocytopenia caused by autoantibodies against platelet antigens. It is one of the more common causes of thrombocytopenia in otherwise asymptomatic adults. […] Major diagnostic concerns in an adult with suspected ITP are twofold: […] Distinguishing ITP from other causes of thrombocytopenia, which often have a similar presentation but frequently require completely different management approaches […] Determining whether the ITP is primary or secondary to an underlying condition that might also benefit from treatment […] The lack of a sensitive or specific diagnostic test for ITP and the large number of other potential causes of thrombocytopenia, some of which may be overlooked (eg, drug-induced thrombocytopenia, hereditary thrombocytopenia), also contribute to challenges in diagnosing ITP.

• #6 Pathophysiology, Clinical Manifestations and Diagnosis of Immune Thrombocytopenia: Contextualization from a Historical Perspective

  https://www.mdpi.com/2038-8330/16/2/21

  Immune thrombocytopenia (ITP) is an autoimmune disease characterized by an isolated decrease in the platelet count and an increased risk of bleeding. […] Here, we intend to contextualize the current knowledge on the pathophysiology, terminology, epidemiology, clinical manifestations, diagnosis, and prognosis of ITP from a historical perspective and the first references to the never-stopping garnering of knowledge about this entity. […] Nowadays, the diagnosis of ITP continues to be one of exclusion, with no targeted, sensitive, and specific tests yet available. […] The mandatory evaluations should be performed in all patients. It is essential to investigate a family history of thrombocytopenia and take a rigorous personal history (comorbidities, bleeding history, chronic medication, recent vaccinations, recent intake of drugs or herbal products, duration of thrombocytopenia…).

• #7 Platelet Disorders – Immune Thrombocytopenia (ITP) | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/immune-thrombocytopenia

  To diagnose ITP, your provider will ask about your medical and family history. They will also ask about your symptoms and do a physical exam to look for signs of bleeding. […] Your provider may order one or more of the following blood tests. […] Complete blood count (CBC): This test measures your platelet count and the number of other blood cells in your blood. […] Blood smear: For this test, some of your blood is put on a slide. A microscope is used to look at your platelets. […] Bone marrow tests: These tests check whether your bone marrow is healthy. You may need this test to confirm that you have ITP and not another platelet disorder, especially if your treatment is not working. […] You also may have a blood test to check for the antibodies that attack platelets. […] If you’re at risk for HIV, hepatitis C, or Heliobacter pylori, your provider may screen you for these infections, which might be linked to ITP.

• #8 Immune Thrombocytopenia (ITP): Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/5726-immune-thrombocytopenia

  Immune thrombocytopenia (ITP) is a rare blood disorder that affects how your blood clots. […] Immune thrombocytopenia (ITP) is a form of low platelet count, a condition that keeps your blood from clotting. […] Immune thrombocytopenia happens when your immune system clears your platelets from circulation and your platelet level goes down. […] Healthcare providers classify ITP by the amount of time you’ve had the condition: Acute ITP, which usually goes away within three months. […] How is immune thrombocytopenia diagnosed? […] Before making a diagnosis, your healthcare provider will do a physical exam to check for bleeding on or under your skin. […] Providers may do the following tests: Complete blood count (CBC). […] If you’re at risk for HIV, hepatitis C or H. pylori, your provider may do tests for those infections.

• #9 Diagnosing Immune Thrombocytopenia | Hematology-Oncology Associates of CNY

  https://www.hoacny.com/patient-resources/blood-disorders/immune-thrombocytopenia/diagnosing-immune-thrombocytopenia

  Your doctor will diagnose immune thrombocytopenia (ITP) based on your medical history, a physical exam, and test results. […] You’ll likely have blood tests to check your platelet count. These tests usually include: […] A complete blood count. This test checks the number of red blood cells, white blood cells, and platelets in your blood. In ITP, the red and white blood cell counts are normal, but the platelet count is low. […] If blood tests show that your platelet count is low, your doctor may recommend more tests to confirm a diagnosis of ITP. For example, bone marrow tests can show whether your bone marrow is making enough platelets. […] If you’re at risk for HIV, hepatitis C, or H. pylori, your doctor may screen you for these infections, which might be linked to ITP. […] Some people who have mild ITP have few or no signs of bleeding. They may be diagnosed only if a blood test done for another reason shows that they have low platelet counts.

• #10 Immune Thrombocytopenia (ITP): Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/5726-immune-thrombocytopenia

  Immune thrombocytopenia (ITP) is a rare blood disorder that affects how your blood clots. […] Immune thrombocytopenia (ITP) is a form of low platelet count, a condition that keeps your blood from clotting. […] Immune thrombocytopenia happens when your immune system clears your platelets from circulation and your platelet level goes down. […] Healthcare providers classify ITP by the amount of time you’ve had the condition: Acute ITP, which usually goes away within three months. […] How is immune thrombocytopenia diagnosed? […] Before making a diagnosis, your healthcare provider will do a physical exam to check for bleeding on or under your skin. […] Providers may do the following tests: Complete blood count (CBC). […] If you’re at risk for HIV, hepatitis C or H. pylori, your provider may do tests for those infections.

• #11 Diagnosing Immune Thrombocytopenia | Hematology-Oncology Associates of CNY

  https://www.hoacny.com/patient-resources/blood-disorders/immune-thrombocytopenia/diagnosing-immune-thrombocytopenia

  Your doctor will diagnose immune thrombocytopenia (ITP) based on your medical history, a physical exam, and test results. […] You’ll likely have blood tests to check your platelet count. These tests usually include: […] A complete blood count. This test checks the number of red blood cells, white blood cells, and platelets in your blood. In ITP, the red and white blood cell counts are normal, but the platelet count is low. […] If blood tests show that your platelet count is low, your doctor may recommend more tests to confirm a diagnosis of ITP. For example, bone marrow tests can show whether your bone marrow is making enough platelets. […] If you’re at risk for HIV, hepatitis C, or H. pylori, your doctor may screen you for these infections, which might be linked to ITP. […] Some people who have mild ITP have few or no signs of bleeding. They may be diagnosed only if a blood test done for another reason shows that they have low platelet counts.

• #12 Immune Thrombocytopenia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562282/

  Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by a low platelet count, purpura, and hemorrhagic episodes. […] The diagnosis is typically made by excluding known thrombocytopenia causes. […] The American Society of Hematology (ASH) defines ITP as a generalized purpuric rash accompanied by a platelet count less than 100,000/L and normal white blood cell (WBC) count and hemoglobin level. […] Initial laboratory evaluation for children and adults should include a complete blood count (CBC) with differential WBC count, reticulocyte count, and peripheral blood smear (PBS). […] The WBC count, hemoglobin concentration, red cell indices, and leukocyte differential are usually normal in patients with ITP. However, the platelet count is characteristically less than 100,000/L.

• #13 Immune Thrombocytopenia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/23385

  Immune thrombocytopenia (ITP), formerly idiopathic thrombocytopenic purpura, is a condition arising from immunoglobulin G (IgG) autoantibodies sensitizing circulating platelets, manifesting as a low platelet count, purpura, and hemorrhagic episodes. The diagnosis is typically made by excluding known thrombocytopenia causes. ITP can affect both children and adults. The American Society of Hematology (ASH) defines ITP as a generalized purpuric rash accompanied by a platelet count less than 100,000/L and normal white blood cell (WBC) count and hemoglobin level. […] ITP is a diagnosis of exclusion. Diagnostic testing can help determine the cause of thrombocytopenia or rule out other disorders with similar presentations. […] Initial laboratory evaluation for children and adults should include a complete blood count (CBC) with differential WBC count, reticulocyte count, and peripheral blood smear (PBS). The WBC count, hemoglobin concentration, red cell indices, and leukocyte differential are usually normal in patients with ITP. However, the platelet count is characteristically less than 100,000/L.

• #14 Immune thrombocytopenia (ITP) in children: Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/immune-thrombocytopenia-itp-in-children-clinical-features-and-diagnosis

  Immune thrombocytopenia (ITP) of childhood is characterized by isolated thrombocytopenia (platelet count <100,000/microL with normal white blood cell count, hemoglobin, and blood smear) (table 1). The clinical features and diagnosis of ITP in children will be reviewed here. [...] Initial evaluation [...] Further evaluation [...] Findings suggestive of other diagnoses [...] Indications for bone marrow examination [...] Immature platelet fraction [...] No role for antiplatelet antibody testing [...] DIAGNOSIS [...] Secondary ITP refers to immune-mediated thrombocytopenia with an underlying cause, including drug-induced or associated with systemic illness, such as systemic lupus erythematosus (SLE), infection (eg, HIV), immune deficiency (eg, common variable immunodeficiency [CVID] or autoimmune lymphoproliferative syndrome [ALPS]), and other causes.

• #15 Thrombocytopenia: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0900/thrombocytopenia.html

  Patients with isolated thrombocytopenia in the absence of systemic illness most likely have immune thrombocytopenia or drug-induced thrombocytopenia. […] Initial treatment for immune thrombocytopenia is corticosteroid therapy or intravenous immune globulin (human) infusion. Recurrent or unresponsive cases are treated with thrombopoietin-receptor agonists or immunomodulators (e.g., rituximab). […] There is no specific laboratory test for ITP, so it is often a diagnosis of exclusion. Primary ITP is distinguished from secondary ITP by the absence of chronic medical conditions or acute infections. […] Patients often require hospitalization, but newly diagnosed ITP with platelet counts of 20 103 per L or greater in patients who are asymptomatic or with minimal mucosal bleeding can be managed in the outpatient setting, provided that definitive hematology follow-up is performed within 24 to 72 hours. […] Initial therapy is corticosteroids or intravenous immune globulin (human) infusion. Recurrent or unresponsive cases are treated with thrombopoietin receptor agonists or immunomodulators (e.g., rituximab).

• #16 Immune Thrombocytopenia (ITP) Workup: Laboratory Studies, Imaging Studies, Histologic Findings

  https://emedicine.medscape.com/article/202158-workup

  The workup for immune thrombocytopenia (ITP) starts with a complete blood cell (CBC) count. The hallmark of ITP is isolated thrombocytopenia; anemia and/or neutropenia may indicate other diseases […] The diagnosis of this type of pseudothrombocytopenia is established if the platelet count is normal when repeated on a sample from heparin-anticoagulated or citrate-anticoagulated blood. […] In selected women, the medical history may suggest a chronic, recurrent, multisystemic illness with vague, generalized signs or symptoms, such as recurrent, multiple, painful, tender, or swollen joints. In such cases, a negative antinuclear antibody (ANA) result is useful in diagnosing ITP if the patient’s thrombocytopenia becomes chronic and resistant to treatment. […] The reliability of the results of a platelet antibody test is highly specific to the laboratory used. A negative antiplatelet antibody assay result does not exclude the diagnosis of ITP.

• #17 Making a Diagnosis of Immune Thrombocytopenia

  https://www.onclive.com/view/making-a-diagnosis-of-immune-thrombocytopenia

  A patient might have macrocytosis, and back of that also the white [blood cell] count and differential. Finally, obviously, the platelet count. […] I might bring up an interesting and important aspect that people dont look at often. Thats the mean platelet volume, MPV. […] Theres good data, particularly from the Europeans, that MPVs above 12.4 could often suggest another diagnosis, being potential congenital thrombocytopenia. […] I mention that because I learned when I was a medical student there are big platelets in ITP, but the majority, over 90% of them, their MPVs are down. […] Then essential to that is you have to look at the blood smear. You have to rule out platelet clumping. […] I think a failure to look at blood smears is often the failure that many clinicians do due to time and other reasons.

• #18 Immune Thrombocytopenia (ITP) Workup: Laboratory Studies, Imaging Studies, Histologic Findings

  https://emedicine.medscape.com/article/202158-workup

  The workup for immune thrombocytopenia (ITP) starts with a complete blood cell (CBC) count. The hallmark of ITP is isolated thrombocytopenia; anemia and/or neutropenia may indicate other diseases […] The diagnosis of this type of pseudothrombocytopenia is established if the platelet count is normal when repeated on a sample from heparin-anticoagulated or citrate-anticoagulated blood. […] In selected women, the medical history may suggest a chronic, recurrent, multisystemic illness with vague, generalized signs or symptoms, such as recurrent, multiple, painful, tender, or swollen joints. In such cases, a negative antinuclear antibody (ANA) result is useful in diagnosing ITP if the patient’s thrombocytopenia becomes chronic and resistant to treatment. […] The reliability of the results of a platelet antibody test is highly specific to the laboratory used. A negative antiplatelet antibody assay result does not exclude the diagnosis of ITP.

• #19 Making a Diagnosis of Immune Thrombocytopenia

  https://www.onclive.com/view/making-a-diagnosis-of-immune-thrombocytopenia

  A patient might have macrocytosis, and back of that also the white [blood cell] count and differential. Finally, obviously, the platelet count. […] I might bring up an interesting and important aspect that people dont look at often. Thats the mean platelet volume, MPV. […] Theres good data, particularly from the Europeans, that MPVs above 12.4 could often suggest another diagnosis, being potential congenital thrombocytopenia. […] I mention that because I learned when I was a medical student there are big platelets in ITP, but the majority, over 90% of them, their MPVs are down. […] Then essential to that is you have to look at the blood smear. You have to rule out platelet clumping. […] I think a failure to look at blood smears is often the failure that many clinicians do due to time and other reasons.

• #20 Making a Diagnosis of Immune Thrombocytopenia

  https://www.onclive.com/view/making-a-diagnosis-of-immune-thrombocytopenia

  A patient might have macrocytosis, and back of that also the white [blood cell] count and differential. Finally, obviously, the platelet count. […] I might bring up an interesting and important aspect that people dont look at often. Thats the mean platelet volume, MPV. […] Theres good data, particularly from the Europeans, that MPVs above 12.4 could often suggest another diagnosis, being potential congenital thrombocytopenia. […] I mention that because I learned when I was a medical student there are big platelets in ITP, but the majority, over 90% of them, their MPVs are down. […] Then essential to that is you have to look at the blood smear. You have to rule out platelet clumping. […] I think a failure to look at blood smears is often the failure that many clinicians do due to time and other reasons.

• #21 Immune thrombocytopenia – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/138

  Immune thrombocytopenia (ITP) in children typically presents with a preceding viral illness and an abrupt onset. There is a female preponderance among adults, who may present with thrombocytopenia with or without bleeding. […] Full blood count and peripheral blood smear show isolated thrombocytopenia. […] Initial treatment options for newly diagnosed ITP include observation, or a corticosteroid and/or IVIG depending on platelet count and bleeding symptoms. […] Diagnostic investigations include FBC and peripheral blood smear. […] Investigations to consider include HIV serology, Helicobacter pylori breath test or stool antigen test, hepatitis C serology, thyroid function tests and antithyroid antibody tests, quantitative immunoglobulins, bone marrow biopsy/aspiration, and pregnancy test.

• #22 Immune thrombocytopenia – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/138

  Immune thrombocytopenia (ITP) in children typically presents with a preceding viral illness and an abrupt onset. There is a female preponderance among adults, who may present with thrombocytopenia with or without bleeding. […] Full blood count and peripheral blood smear show isolated thrombocytopenia. […] Initial treatment options for newly diagnosed ITP include observation, or a corticosteroid and/or IVIG depending on platelet count and bleeding symptoms. […] Diagnostic investigations include FBC and peripheral blood smear. […] Investigations to consider include HIV serology, Helicobacter pylori breath test or stool antigen test, hepatitis C serology, thyroid function tests and antithyroid antibody tests, quantitative immunoglobulins, bone marrow biopsy/aspiration, and pregnancy test.

• #23 Platelet Disorders – Immune Thrombocytopenia (ITP) | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/immune-thrombocytopenia

  To diagnose ITP, your provider will ask about your medical and family history. They will also ask about your symptoms and do a physical exam to look for signs of bleeding. […] Your provider may order one or more of the following blood tests. […] Complete blood count (CBC): This test measures your platelet count and the number of other blood cells in your blood. […] Blood smear: For this test, some of your blood is put on a slide. A microscope is used to look at your platelets. […] Bone marrow tests: These tests check whether your bone marrow is healthy. You may need this test to confirm that you have ITP and not another platelet disorder, especially if your treatment is not working. […] You also may have a blood test to check for the antibodies that attack platelets. […] If you’re at risk for HIV, hepatitis C, or Heliobacter pylori, your provider may screen you for these infections, which might be linked to ITP.

• #24 Immune Thrombocytopenia (ITP): Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/5726-immune-thrombocytopenia

  Immune thrombocytopenia (ITP) is a rare blood disorder that affects how your blood clots. […] Immune thrombocytopenia (ITP) is a form of low platelet count, a condition that keeps your blood from clotting. […] Immune thrombocytopenia happens when your immune system clears your platelets from circulation and your platelet level goes down. […] Healthcare providers classify ITP by the amount of time you’ve had the condition: Acute ITP, which usually goes away within three months. […] How is immune thrombocytopenia diagnosed? […] Before making a diagnosis, your healthcare provider will do a physical exam to check for bleeding on or under your skin. […] Providers may do the following tests: Complete blood count (CBC). […] If you’re at risk for HIV, hepatitis C or H. pylori, your provider may do tests for those infections.

• #25 How we treat primary immune thrombocytopenia in adults | Journal of Hematology & Oncology | Full Text

  https://jhoonline.biomedcentral.com/articles/10.1186/s13045-023-01401-z

  Primary immune thrombocytopenia (ITP) is an immune-mediated bleeding disorder characterized by decreased platelet counts and an increased risk of bleeding. […] The diagnosis remains a clinical exclusion of other causes of thrombocytopenia. […] The international working group (IWG) on ITP and the American Society of Hematology (ASH) both updated their guidelines for the diagnosis and management of ITP in 2019. […] Therefore, the diagnosis of ITP can be established with careful history taking and physical examination, as well as a review of peripheral blood smears and minimal further testing in most patients. […] However, the application of this diagnostic criterion will lead to misdiagnosis in a small proportion of patients with suspected ITP. […] To minimize the misdiagnosis rate, the Chinese ITP guidelines also recommend bone marrow examination and tests for antinuclear antibodies (ANAs), anti-phospholipid antibodies (APLAs), anti-thyroid antibodies, thyroid function, and coagulation parameters as the basic evaluation.

• #26 Pathophysiology, Clinical Manifestations and Diagnosis of Immune Thrombocytopenia: Contextualization from a Historical Perspective

  https://www.mdpi.com/2038-8330/16/2/21

  The peripheral blood smear is mandatory and should be the first step in the study of all thrombocytopenias in order to rule out pseudothrombocytopenia or abnormalities that indicate other associated pathologies. […] The prevalence of antiphospholipid antibodies (APLAs) in patients with primary ITP is higher compared to the general population and is estimated to be between 25 and 75% depending on the series. […] Antinuclear antibodies (ANA) are present in 13–65% of adults with ITP and could be a predictor of chronicity in addition to being useful to exclude systemic lupus erythematosus. […] Regardless of age, routine bone marrow testing is not necessary for the diagnosis of ITP, as long as the clinical history, physical examination, complete blood count, and peripheral blood smear do not show abnormalities different from those observed in isolated thrombocytopenia.

• #27 Pathophysiology, Clinical Manifestations and Diagnosis of Immune Thrombocytopenia: Contextualization from a Historical Perspective

  https://www.mdpi.com/2038-8330/16/2/21

  The peripheral blood smear is mandatory and should be the first step in the study of all thrombocytopenias in order to rule out pseudothrombocytopenia or abnormalities that indicate other associated pathologies. […] The prevalence of antiphospholipid antibodies (APLAs) in patients with primary ITP is higher compared to the general population and is estimated to be between 25 and 75% depending on the series. […] Antinuclear antibodies (ANA) are present in 13–65% of adults with ITP and could be a predictor of chronicity in addition to being useful to exclude systemic lupus erythematosus. […] Regardless of age, routine bone marrow testing is not necessary for the diagnosis of ITP, as long as the clinical history, physical examination, complete blood count, and peripheral blood smear do not show abnormalities different from those observed in isolated thrombocytopenia.

• #28 Immune Thrombocytopenia (ITP) Workup: Laboratory Studies, Imaging Studies, Histologic Findings

  https://emedicine.medscape.com/article/202158-workup

  The workup for immune thrombocytopenia (ITP) starts with a complete blood cell (CBC) count. The hallmark of ITP is isolated thrombocytopenia; anemia and/or neutropenia may indicate other diseases […] The diagnosis of this type of pseudothrombocytopenia is established if the platelet count is normal when repeated on a sample from heparin-anticoagulated or citrate-anticoagulated blood. […] In selected women, the medical history may suggest a chronic, recurrent, multisystemic illness with vague, generalized signs or symptoms, such as recurrent, multiple, painful, tender, or swollen joints. In such cases, a negative antinuclear antibody (ANA) result is useful in diagnosing ITP if the patient’s thrombocytopenia becomes chronic and resistant to treatment. […] The reliability of the results of a platelet antibody test is highly specific to the laboratory used. A negative antiplatelet antibody assay result does not exclude the diagnosis of ITP.

• #29 Immune Thrombocytopenia (ITP) Workup: Laboratory Studies, Imaging Studies, Histologic Findings

  https://emedicine.medscape.com/article/202158-workup

  American Society of Hematology guidelines advise that bone marrow examination is not necessary in children and adolescents with the typical features of ITP, or in children in whom intravenous immunoglobulin therapy fails. The guidelines suggest that bone marrow examination is also not necessary in similar patients before initiation of treatment with corticosteroids or before splenectomy. […] Bone marrow examination is indicated in children with atypical hematologic findings, such as immature cells on the peripheral smear or persistent neutropenia.

• #30 Pathophysiology, Clinical Manifestations and Diagnosis of Immune Thrombocytopenia: Contextualization from a Historical Perspective

  https://www.mdpi.com/2038-8330/16/2/21

  The peripheral blood smear is mandatory and should be the first step in the study of all thrombocytopenias in order to rule out pseudothrombocytopenia or abnormalities that indicate other associated pathologies. […] The prevalence of antiphospholipid antibodies (APLAs) in patients with primary ITP is higher compared to the general population and is estimated to be between 25 and 75% depending on the series. […] Antinuclear antibodies (ANA) are present in 13–65% of adults with ITP and could be a predictor of chronicity in addition to being useful to exclude systemic lupus erythematosus. […] Regardless of age, routine bone marrow testing is not necessary for the diagnosis of ITP, as long as the clinical history, physical examination, complete blood count, and peripheral blood smear do not show abnormalities different from those observed in isolated thrombocytopenia.

• #31 Immune Thrombocytopenia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/23385

  Blood typing is usually performed if the patient needs a blood transfusion. Meanwhile, direct and indirect antiplatelet autoantibody tests have high specificity but low sensitivity for ITP. Antiplatelet antibody testing is not recommended when evaluating ITP as it does not correlate with clinical outcomes. […] Bone marrow biopsy is no longer performed for typical ITP presentations in both adults and children. Bone marrow aspiration and biopsy are indicated if clinical or laboratory findings suggest malignancy or bone marrow failure. Such findings include lymph node enlargement, splenomegaly, neutropenia, leukocytosis, atypical lymphocytosis, or anemia in the presence of bone pain, fevers, or unintentional weight loss. Unresponsiveness to immunosuppressants also warrants bone marrow analysis.

• #32 Immune Thrombocytopenia (ITP) – Hematology and Oncology – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hematology-and-oncology/thrombocytopenia-and-platelet-dysfunction/immune-thrombocytopenia-itp

  Testing for antiplatelet antibodies may aid the diagnosis in some cases. […] Bone marrow examination is not required to make the diagnosis but is done if blood counts or blood smear reveals abnormalities in addition to thrombocytopenia, when clinical features are not typical, or if patients fail to respond to standard therapies (eg, corticosteroids). […] In patients with ITP, bone marrow examination reveals normal or possibly increased numbers of megakaryocytes in an otherwise normal bone marrow sample. […] Corticosteroids (and sometimes intravenous immune globulin (IVIG) or IV anti-D immune globulin) are first-line treatments for bleeding or severe thrombocytopenia. […] Bone marrow biopsy is typically not needed unless there are other concerning red or white blood cell abnormalities or in patients being considered for splenectomy who have not responded to standard treatment with corticosteroids or IVIG. […] Thrombopoietin receptor agonists are highly effective in maintaining a safe platelet count in 85% of adults. […] Splenectomy is often effective but is reserved for patients in whom medical therapy is ineffective or those whose disease persists after 12 months.

• #33 Immune Thrombocytopenia (ITP): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/202158-overview

  Immune thrombocytopenia (ITP) is a syndrome in which platelets become coated with autoantibodies to platelet membrane antigens, resulting in splenic sequestration and phagocytosis by mononuclear macrophages. […] ITP is diagnosed by excluding other diseases; therefore, the absence of other findings from the peripheral smear is at least as important as the observed findings. […] No single laboratory result or clinical finding establishes a diagnosis of ITP; it is a diagnosis of exclusion. […] The value of bone marrow evaluation for a diagnosis of ITP is unresolved. […] In adults older than 60 years, biopsy is used to exclude myelodysplastic syndrome or leukemia. […] Unresponsiveness to standard treatment after 6 months is an indication for bone marrow aspiration.

• #34 Immune Thrombocytopenia (ITP) – Hematology and Oncology – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hematology-and-oncology/thrombocytopenia-and-platelet-dysfunction/immune-thrombocytopenia-itp

  Testing for antiplatelet antibodies may aid the diagnosis in some cases. […] Bone marrow examination is not required to make the diagnosis but is done if blood counts or blood smear reveals abnormalities in addition to thrombocytopenia, when clinical features are not typical, or if patients fail to respond to standard therapies (eg, corticosteroids). […] In patients with ITP, bone marrow examination reveals normal or possibly increased numbers of megakaryocytes in an otherwise normal bone marrow sample. […] Corticosteroids (and sometimes intravenous immune globulin (IVIG) or IV anti-D immune globulin) are first-line treatments for bleeding or severe thrombocytopenia. […] Bone marrow biopsy is typically not needed unless there are other concerning red or white blood cell abnormalities or in patients being considered for splenectomy who have not responded to standard treatment with corticosteroids or IVIG. […] Thrombopoietin receptor agonists are highly effective in maintaining a safe platelet count in 85% of adults. […] Splenectomy is often effective but is reserved for patients in whom medical therapy is ineffective or those whose disease persists after 12 months.

• #35 Immune Thrombocytopenia (ITP) – Hematology and Oncology – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hematology-and-oncology/thrombocytopenia-and-platelet-dysfunction/immune-thrombocytopenia-itp

  Testing for antiplatelet antibodies may aid the diagnosis in some cases. […] Bone marrow examination is not required to make the diagnosis but is done if blood counts or blood smear reveals abnormalities in addition to thrombocytopenia, when clinical features are not typical, or if patients fail to respond to standard therapies (eg, corticosteroids). […] In patients with ITP, bone marrow examination reveals normal or possibly increased numbers of megakaryocytes in an otherwise normal bone marrow sample. […] Corticosteroids (and sometimes intravenous immune globulin (IVIG) or IV anti-D immune globulin) are first-line treatments for bleeding or severe thrombocytopenia. […] Bone marrow biopsy is typically not needed unless there are other concerning red or white blood cell abnormalities or in patients being considered for splenectomy who have not responded to standard treatment with corticosteroids or IVIG. […] Thrombopoietin receptor agonists are highly effective in maintaining a safe platelet count in 85% of adults. […] Splenectomy is often effective but is reserved for patients in whom medical therapy is ineffective or those whose disease persists after 12 months.

• #36 Immune thrombocytopenic purpura – Wikipedia

  https://en.wikipedia.org/wiki/Immune_thrombocytopenic_purpura

  Diagnosis of ITP involves identifying a low platelet count through a complete blood count, a common blood test. However, since the diagnosis relies on excluding other potential causes of a low platelet count, additional investigations, such as a bone marrow biopsy, may be necessary in certain cases. […] Bone marrow examination may be performed on patients over the age of 60 and those who do not respond to treatment, or when the diagnosis is in doubt. On examination of the marrow, an increase in the production of megakaryocytes may be observed and may help in establishing a diagnosis of ITP. An analysis for anti-platelet antibodies is a matter of clinician’s preference, as there is disagreement on whether the 80 percent specificity of this test is sufficient to be clinically useful.

• #37 Immune Thrombocytopenia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/23385

  Blood typing is usually performed if the patient needs a blood transfusion. Meanwhile, direct and indirect antiplatelet autoantibody tests have high specificity but low sensitivity for ITP. Antiplatelet antibody testing is not recommended when evaluating ITP as it does not correlate with clinical outcomes. […] Bone marrow biopsy is no longer performed for typical ITP presentations in both adults and children. Bone marrow aspiration and biopsy are indicated if clinical or laboratory findings suggest malignancy or bone marrow failure. Such findings include lymph node enlargement, splenomegaly, neutropenia, leukocytosis, atypical lymphocytosis, or anemia in the presence of bone pain, fevers, or unintentional weight loss. Unresponsiveness to immunosuppressants also warrants bone marrow analysis.

• #38

  https://journals.lww.com/bloodcoagulation/fulltext/2022/09000/primary_immune_thrombocytopenia__a__diagnosis_of.1.aspx

  Assays for antibodies to specific platelet glycoproteins are not routinely recommended as platelet-associated IgG is elevated in both immune and nonimmune thrombocytopenia. […] Testing for antinuclear antibody (ANA) or other serological tests are not recommended in children and adults with suspected ITP. […] The presence of APLA does not appear to affect the response to treatment in ITP. […] However, response to these agents may occur in other conditions. […] The diagnosis of ITP needs great caution and follow-up as this may convert to other immune-mediated disorders over time. […] The heterogeneity of ITP is demonstrated by the bleeding symptoms. […] There appears to be no agreement regarding the tests needed to complete the diagnostic work-up. […] Identifying the underlying cause of thrombocytopenia is crucial for the management of ITP.

• #39 Pathophysiology, Clinical Manifestations and Diagnosis of Immune Thrombocytopenia: Contextualization from a Historical Perspective

  https://www.mdpi.com/2038-8330/16/2/21

  A systematic review and meta-analysis of platelet auto-antibody tests (anti-GPIIb/IIIa or anti-GPIb) in the diagnosis of ITP showed that the sensitivity and specificity of direct tests were 53% and 93%, respectively. […] Therefore, the determination of platelet autoantibodies in patients with ITP has high specificity, but low sensitivity. A positive test could be useful to confirm ITP, but a negative test does not rule it out.

• #40 Pathophysiology, Clinical Manifestations and Diagnosis of Immune Thrombocytopenia: Contextualization from a Historical Perspective

  https://www.mdpi.com/2038-8330/16/2/21

  A systematic review and meta-analysis of platelet auto-antibody tests (anti-GPIIb/IIIa or anti-GPIb) in the diagnosis of ITP showed that the sensitivity and specificity of direct tests were 53% and 93%, respectively. […] Therefore, the determination of platelet autoantibodies in patients with ITP has high specificity, but low sensitivity. A positive test could be useful to confirm ITP, but a negative test does not rule it out.

• #41 Immune Thrombocytopenia (ITP) Workup: Laboratory Studies, Imaging Studies, Histologic Findings

  https://emedicine.medscape.com/article/202158-workup

  The workup for immune thrombocytopenia (ITP) starts with a complete blood cell (CBC) count. The hallmark of ITP is isolated thrombocytopenia; anemia and/or neutropenia may indicate other diseases […] The diagnosis of this type of pseudothrombocytopenia is established if the platelet count is normal when repeated on a sample from heparin-anticoagulated or citrate-anticoagulated blood. […] In selected women, the medical history may suggest a chronic, recurrent, multisystemic illness with vague, generalized signs or symptoms, such as recurrent, multiple, painful, tender, or swollen joints. In such cases, a negative antinuclear antibody (ANA) result is useful in diagnosing ITP if the patient’s thrombocytopenia becomes chronic and resistant to treatment. […] The reliability of the results of a platelet antibody test is highly specific to the laboratory used. A negative antiplatelet antibody assay result does not exclude the diagnosis of ITP.

• #42 How we treat primary immune thrombocytopenia in adults | Journal of Hematology & Oncology | Full Text

  https://jhoonline.biomedcentral.com/articles/10.1186/s13045-023-01401-z

  The presence of anti-GP autoantibodies is helpful to confirm the diagnosis of immune thrombocytopenia, while it cannot distinguish the primary from the secondary ITP. […] It should be emphasized that the response to treatments, especially intravenous immunoglobulin (IVIg), is of great value for the confirmation of ITP diagnosis. […] Therefore, it is critical to re-evaluate the diagnosis during the course of the disease, especially in patients who respond poorly to treatment and cases with new symptoms, signs, and new laboratory findings. […] According to the disease duration, ITP can be divided into newly diagnosed (<3 months), persistent (3–12 months), and chronic (>12 months) phases. […] The IWG does not use the term “refractory” anymore because of the declining rate of splenectomy.

• #43 Novel Biomarkers for Diagnosis and Monitoring of Immune Thrombocytopenia

  https://www.mdpi.com/1422-0067/24/5/4438

  Lower-than-normal platelet counts are a hallmark of the acquired autoimmune illness known as immune thrombocytopenia, which can affect both adults and children. […] Immune thrombocytopenia patients’ care has evolved significantly in recent years, but the disease’s diagnosis has not, and it is still only clinically achievable with the elimination of other causes of thrombocytopenia. […] The lack of a valid biomarker or gold-standard diagnostic test, despite ongoing efforts to find one, adds to the high rate of disease misdiagnosis. […] Current recommendations state that ITP can be identified in individuals with isolated thrombocytopenia, a platelet count of 100 × 10^9 L, anaemia or leukopenia, and no other thrombocytopenia-causing conditions. […] The lack of a trustworthy biomarker or gold-standard diagnostic test, despite the ongoing search for one, adds to the high likelihood of disease misdiagnosis.

• #44 Novel Biomarkers for Diagnosis and Monitoring of Immune Thrombocytopenia

  https://www.mdpi.com/1422-0067/24/5/4438

  This review summarizes the state-of-the-art research in identifying novel biomarkers that can aid in ITP diagnosis, forecast prognosis, and direct therapeutic treatment through indices that can assess patient receptivity to potential therapies. […] The accurate detection of platelet autoantibodies would support the clinical diagnosis, but their utility in the thrombocytopenia diagnostic workup is constrained by the low specificity and sensitivity of the currently available methods for platelet autoantibody testing. […] Therefore, additional advancements in autoantibody detection technologies will be required to boost sensitivity to a level suitable for ITP diagnosis. […] The immature platelet fraction (IPF) is one of these markers, which is easily accessible in contemporary automated haematology analysers with fluorescence capacity.

• #45 Novel Biomarkers for Diagnosis and Monitoring of Immune Thrombocytopenia

  https://www.mdpi.com/1422-0067/24/5/4438

  IPF can be precisely detected in blood samples even 24 h after they have been drawn, most likely because they live longer than mature platelets. […] Thus, these counts may indicate whether the cause of the thrombocytopenia is central (originating in the bone marrow) or peripheral (originating elsewhere). […] In comparison to a control group, patients with ITP had a higher IPF value and a lower platelet count, according to a study. […] Other studies have confirmed the possibility to use IPF to distinguish thrombocytopenia for platelet consumption, supporting its utility in research into the causes of thrombocytopenia. […] The protein biomarker known as tumour necrosis factor-related apoptosis-inducing ligand (TRAIL) is a member of the TNF superfamily. […] It was shown that reduced platelet formation in ITP was caused by low expression of TRAIL in megakaryocytes.

• #46 Novel Biomarkers for Diagnosis and Monitoring of Immune Thrombocytopenia

  https://www.mdpi.com/1422-0067/24/5/4438

  IPF can be precisely detected in blood samples even 24 h after they have been drawn, most likely because they live longer than mature platelets. […] Thus, these counts may indicate whether the cause of the thrombocytopenia is central (originating in the bone marrow) or peripheral (originating elsewhere). […] In comparison to a control group, patients with ITP had a higher IPF value and a lower platelet count, according to a study. […] Other studies have confirmed the possibility to use IPF to distinguish thrombocytopenia for platelet consumption, supporting its utility in research into the causes of thrombocytopenia. […] The protein biomarker known as tumour necrosis factor-related apoptosis-inducing ligand (TRAIL) is a member of the TNF superfamily. […] It was shown that reduced platelet formation in ITP was caused by low expression of TRAIL in megakaryocytes.

• #47

  https://link.springer.com/article/10.1007/s12185-023-03672-1

  Our research group has tackled this issue for many years. In 2006, we proposed diagnostic criteria incorporating anti-GPIIb/IIIa antibody-producing B cells (ELISPOT), platelet-associated (PA) anti-GPIIb/IIIa antibodies, plasma thrombopoietin (TPO) levels, and percentage of reticulated platelets (RP%). Here, we have proposed new diagnostic criteria involving the measurement of plasma TPO levels and percentage of immature platelet fraction, which includes RP%. […] These biomarkers reflect the pathology of ITP, which is characterized by a shortened platelet lifespan associated with platelet destruction and relatively maintained platelet production. […] While our diagnostic criteria resemble the previous criteria in that they emphasize the exclusion of many other diseases, these new criteria enable clear differentiation of ITP from aplastic anemia and other forms of hypoplastic thrombocytopenia. Therefore, our new diagnostic criteria can be highly useful in clinical practice for avoiding unnecessary bone marrow examination as well as appropriate selection of treatments.

• #48

  https://link.springer.com/article/10.1007/s12185-023-03672-1

  Primary immune thrombocytopenia (ITP) is an autoimmune disorder characterized by isolated thrombocytopenia due to accelerated platelet destruction and impaired platelet production. Diagnosis of ITP is still challenging because ITP has been diagnosed by exclusion. Exclusion of thrombocytopenia due to bone marrow failure is especially important in Japan because of high prevalence of aplastic anemia compared to Western countries. Hence, we propose a new diagnostic criteria involving the measurement of plasma thrombopoietin (TPO) levels and percentage of immature platelet fraction (RP% or IPF%); 1) isolated thrombocytopenia with no morphological evidence of dysplasia in any blood cell type in a blood smear, 2) normal or slightly increased plasma TPO level (cutoff), 3) elevated RP% or IPF% (upper limit of normal), and 4) absence of other conditions that potentially cause thrombocytopenia including secondary ITP. A diagnosis of ITP is made if conditions 1-4 are all met.

• #49

  https://link.springer.com/article/10.1007/s12185-023-03672-1

  A diagnosis of ITP is made if conditions 1 – 4 above are all met. […] A typical case of ITP meets all conditions 1-4. In particular, a combination of plasma TPO level and IPF% can distinguish ITP from hypoplastic thrombocytopenia with high sensitivity and specificity. […] However, plasma TPO levels occasionally exceed standard levels, and plasma TPO levels in acute phase of ITP may be higher as compared in chronic ITP. […] Therefore, cases that do not meet the criteria for either plasma TPO level or elevated percentage of immature platelet fraction are diagnosed as possible ITP. When possible, a diagnosis of ITP should be made based on GP-specific platelet antibodies or a GP-specific antiplatelet antibody-producing B cell (ELISPOT) test.

• #50

  https://link.springer.com/article/10.1007/s12185-023-03672-1

  Primary immune thrombocytopenia (ITP) is an autoimmune disorder characterized by isolated thrombocytopenia due to accelerated platelet destruction and impaired platelet production. Diagnosis of ITP is still challenging because ITP has been diagnosed by exclusion. Exclusion of thrombocytopenia due to bone marrow failure is especially important in Japan because of high prevalence of aplastic anemia compared to Western countries. Hence, we propose a new diagnostic criteria involving the measurement of plasma thrombopoietin (TPO) levels and percentage of immature platelet fraction (RP% or IPF%); 1) isolated thrombocytopenia with no morphological evidence of dysplasia in any blood cell type in a blood smear, 2) normal or slightly increased plasma TPO level (cutoff), 3) elevated RP% or IPF% (upper limit of normal), and 4) absence of other conditions that potentially cause thrombocytopenia including secondary ITP. A diagnosis of ITP is made if conditions 1-4 are all met.

• #51

  https://link.springer.com/article/10.1007/s12185-023-03672-1

  Primary immune thrombocytopenia (ITP) is an autoimmune disorder characterized by isolated thrombocytopenia due to accelerated platelet destruction and impaired platelet production. Diagnosis of ITP is still challenging because ITP has been diagnosed by exclusion. Exclusion of thrombocytopenia due to bone marrow failure is especially important in Japan because of high prevalence of aplastic anemia compared to Western countries. Hence, we propose a new diagnostic criteria involving the measurement of plasma thrombopoietin (TPO) levels and percentage of immature platelet fraction (RP% or IPF%); 1) isolated thrombocytopenia with no morphological evidence of dysplasia in any blood cell type in a blood smear, 2) normal or slightly increased plasma TPO level (cutoff), 3) elevated RP% or IPF% (upper limit of normal), and 4) absence of other conditions that potentially cause thrombocytopenia including secondary ITP. A diagnosis of ITP is made if conditions 1-4 are all met.

• #52 Novel Biomarkers for Diagnosis and Monitoring of Immune Thrombocytopenia

  https://www.mdpi.com/1422-0067/24/5/4438

  IPF can be precisely detected in blood samples even 24 h after they have been drawn, most likely because they live longer than mature platelets. […] Thus, these counts may indicate whether the cause of the thrombocytopenia is central (originating in the bone marrow) or peripheral (originating elsewhere). […] In comparison to a control group, patients with ITP had a higher IPF value and a lower platelet count, according to a study. […] Other studies have confirmed the possibility to use IPF to distinguish thrombocytopenia for platelet consumption, supporting its utility in research into the causes of thrombocytopenia. […] The protein biomarker known as tumour necrosis factor-related apoptosis-inducing ligand (TRAIL) is a member of the TNF superfamily. […] It was shown that reduced platelet formation in ITP was caused by low expression of TRAIL in megakaryocytes.

• #53 Novel Biomarkers for Diagnosis and Monitoring of Immune Thrombocytopenia

  https://www.mdpi.com/1422-0067/24/5/4438

  A proposed mechanism by which the megakaryocyte number increases in vitro may be the megakaryocyte death caused by TRAIL in the plasma of ITP patients. […] These findings support BAFF’s potential involvement in the illness and its inclusion in the diagnostic constellation. […] The fundamental cause of ITP’s onset is immunological tolerance. […] These findings suggested that blood levels of IL-1, IL-18, IL-36, and IL-36 could be used as biomarkers to distinguish SLE-TP patients from ITP patients. […] The expression of TRAIL in megakaryocytes could be a useful parameter for the evaluation of bone marrow replicative dynamics. […] The telomeres play a role in replication as well as the preservation of genomic and cellular stability. […] In ITP patients, there was a slight negative connection between platelet count and telomerase activity of CD19+ cells.

• #54 Novel Biomarkers for Diagnosis and Monitoring of Immune Thrombocytopenia

  https://www.mdpi.com/1422-0067/24/5/4438

  A proposed mechanism by which the megakaryocyte number increases in vitro may be the megakaryocyte death caused by TRAIL in the plasma of ITP patients. […] These findings support BAFF’s potential involvement in the illness and its inclusion in the diagnostic constellation. […] The fundamental cause of ITP’s onset is immunological tolerance. […] These findings suggested that blood levels of IL-1, IL-18, IL-36, and IL-36 could be used as biomarkers to distinguish SLE-TP patients from ITP patients. […] The expression of TRAIL in megakaryocytes could be a useful parameter for the evaluation of bone marrow replicative dynamics. […] The telomeres play a role in replication as well as the preservation of genomic and cellular stability. […] In ITP patients, there was a slight negative connection between platelet count and telomerase activity of CD19+ cells.

• #55 Novel Biomarkers for Diagnosis and Monitoring of Immune Thrombocytopenia

  https://www.mdpi.com/1422-0067/24/5/4438

  Telomere length of PBMC was shown to be considerably shorter in active ITP patients compared to controls, and it also tended to be shorter in inactive ITP patients. […] In conclusion, at this time, it would be reasonable to conduct large-scale prospective clinical trials to determine whether anti-oxidants are useful in treating patients with ITP.

• #56 How we treat primary immune thrombocytopenia in adults | Journal of Hematology & Oncology | Full Text

  https://jhoonline.biomedcentral.com/articles/10.1186/s13045-023-01401-z

  Identification of patients at high risk of severe bleeding will help start the treatment timely to prevent fatal hemorrhage, even in those with higher platelet counts, whereas this remains a big challenge. […] Bleeding severity in ITP patients may be graded using the well-established ITP-specific bleeding assessment tool (ITP-BAT), as it is one of the basic determinants of treatment initiation and response evaluation.

• #57 How we treat primary immune thrombocytopenia in adults | Journal of Hematology & Oncology | Full Text

  https://jhoonline.biomedcentral.com/articles/10.1186/s13045-023-01401-z

  Identification of patients at high risk of severe bleeding will help start the treatment timely to prevent fatal hemorrhage, even in those with higher platelet counts, whereas this remains a big challenge. […] Bleeding severity in ITP patients may be graded using the well-established ITP-specific bleeding assessment tool (ITP-BAT), as it is one of the basic determinants of treatment initiation and response evaluation.

• #58

  https://haematologica.org/article/view/haematol.2021.279513

  An important cause of thrombocytopenia in elderly patients is myelodysplastic syndrome. A bone marrow examination is necessary to diagnose this condition. […] Patients over the age of 60 are thought to have a higher likelihood of fatal and non-fatal serious bleeding compared to younger patients; recent studies of intracranial hemorrhage have supported earlier findings demonstrating a higher risk in those above 60 years of age. […] Splenectomy is used even less in this age group, since efficacy is lower, and the risk of side effects is higher. […] The primary advantages remain the high response rate and the low likelihood that there will be major side effects although venous and arterial thrombosis would be the primary concerns in this older man. […] If a treatment is ineffective, continue the treatment and add another treatment initiating combination therapy. […] Various experimental agents for ITP are being studied and other drugs, currently used for other conditions, are now undergoing trials in ITP.

• #59

  https://haematologica.org/article/view/haematol.2021.279513

  An important cause of thrombocytopenia in elderly patients is myelodysplastic syndrome. A bone marrow examination is necessary to diagnose this condition. […] Patients over the age of 60 are thought to have a higher likelihood of fatal and non-fatal serious bleeding compared to younger patients; recent studies of intracranial hemorrhage have supported earlier findings demonstrating a higher risk in those above 60 years of age. […] Splenectomy is used even less in this age group, since efficacy is lower, and the risk of side effects is higher. […] The primary advantages remain the high response rate and the low likelihood that there will be major side effects although venous and arterial thrombosis would be the primary concerns in this older man. […] If a treatment is ineffective, continue the treatment and add another treatment initiating combination therapy. […] Various experimental agents for ITP are being studied and other drugs, currently used for other conditions, are now undergoing trials in ITP.

• #60 Immune thrombocytopenia (ITP) in adults: Clinical manifestations and diagnosis – UpToDate

  https://www.uptodate.com/contents/immune-thrombocytopenia-itp-in-adults-clinical-manifestations-and-diagnosis

  Immune thrombocytopenia (ITP, also called idiopathic thrombocytopenic purpura, immune thrombocytopenic purpura) is an acquired thrombocytopenia caused by autoantibodies against platelet antigens. It is one of the more common causes of thrombocytopenia in otherwise asymptomatic adults. […] Major diagnostic concerns in an adult with suspected ITP are twofold: […] Distinguishing ITP from other causes of thrombocytopenia, which often have a similar presentation but frequently require completely different management approaches […] Determining whether the ITP is primary or secondary to an underlying condition that might also benefit from treatment […] The lack of a sensitive or specific diagnostic test for ITP and the large number of other potential causes of thrombocytopenia, some of which may be overlooked (eg, drug-induced thrombocytopenia, hereditary thrombocytopenia), also contribute to challenges in diagnosing ITP.

• #61 Immune thrombocytopenia (ITP) in children: Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/immune-thrombocytopenia-itp-in-children-clinical-features-and-diagnosis

  Immune thrombocytopenia (ITP) of childhood is characterized by isolated thrombocytopenia (platelet count <100,000/microL with normal white blood cell count, hemoglobin, and blood smear) (table 1). The clinical features and diagnosis of ITP in children will be reviewed here. [...] Initial evaluation [...] Further evaluation [...] Findings suggestive of other diagnoses [...] Indications for bone marrow examination [...] Immature platelet fraction [...] No role for antiplatelet antibody testing [...] DIAGNOSIS [...] Secondary ITP refers to immune-mediated thrombocytopenia with an underlying cause, including drug-induced or associated with systemic illness, such as systemic lupus erythematosus (SLE), infection (eg, HIV), immune deficiency (eg, common variable immunodeficiency [CVID] or autoimmune lymphoproliferative syndrome [ALPS]), and other causes.

• #62 Immune thrombocytopenia (ITP) in children: Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/immune-thrombocytopenia-itp-in-children-clinical-features-and-diagnosis

  Immune thrombocytopenia (ITP) of childhood is characterized by isolated thrombocytopenia (platelet count <100,000/microL with normal white blood cell count, hemoglobin, and blood smear) (table 1). The clinical features and diagnosis of ITP in children will be reviewed here. [...] Initial evaluation [...] Further evaluation [...] Findings suggestive of other diagnoses [...] Indications for bone marrow examination [...] Immature platelet fraction [...] No role for antiplatelet antibody testing [...] DIAGNOSIS [...] Secondary ITP refers to immune-mediated thrombocytopenia with an underlying cause, including drug-induced or associated with systemic illness, such as systemic lupus erythematosus (SLE), infection (eg, HIV), immune deficiency (eg, common variable immunodeficiency [CVID] or autoimmune lymphoproliferative syndrome [ALPS]), and other causes.

• #63 Making a Diagnosis of Immune Thrombocytopenia

  https://www.onclive.com/view/making-a-diagnosis-of-immune-thrombocytopenia

  You can always, if you feel uncomfortable, have a pathologist look at the smear for you. […] Then after that, now you have to look and have a good history to exclude possible drug interactions that might cause thrombocytopenia and new medications and other symptoms that might suggest another diagnosis. […] I think thats really the starting point for the assessment of the patient. […] For us, ITP very similarly remains a diagnosis of exclusion. Youre looking for that isolated thrombocytopenia with really no other findings. […] In children, the typical course is quite different than in adults. The majority of children will get better much faster, but for those children that dont resolve their ITP, we start thinking about it as congenital thrombocytopenia or, to your point, is there some sort of underlying immune dysregulation that really causes a child to have an autoimmune presentation at the age that they did.

• #64

  https://journals.lww.com/bloodcoagulation/fulltext/2022/09000/primary_immune_thrombocytopenia__a__diagnosis_of.1.aspx

  Assays for antibodies to specific platelet glycoproteins are not routinely recommended as platelet-associated IgG is elevated in both immune and nonimmune thrombocytopenia. […] Testing for antinuclear antibody (ANA) or other serological tests are not recommended in children and adults with suspected ITP. […] The presence of APLA does not appear to affect the response to treatment in ITP. […] However, response to these agents may occur in other conditions. […] The diagnosis of ITP needs great caution and follow-up as this may convert to other immune-mediated disorders over time. […] The heterogeneity of ITP is demonstrated by the bleeding symptoms. […] There appears to be no agreement regarding the tests needed to complete the diagnostic work-up. […] Identifying the underlying cause of thrombocytopenia is crucial for the management of ITP.

• #65 How we treat primary immune thrombocytopenia in adults | Journal of Hematology & Oncology | Full Text

  https://jhoonline.biomedcentral.com/articles/10.1186/s13045-023-01401-z

  The presence of anti-GP autoantibodies is helpful to confirm the diagnosis of immune thrombocytopenia, while it cannot distinguish the primary from the secondary ITP. […] It should be emphasized that the response to treatments, especially intravenous immunoglobulin (IVIg), is of great value for the confirmation of ITP diagnosis. […] Therefore, it is critical to re-evaluate the diagnosis during the course of the disease, especially in patients who respond poorly to treatment and cases with new symptoms, signs, and new laboratory findings. […] According to the disease duration, ITP can be divided into newly diagnosed (<3 months), persistent (3–12 months), and chronic (>12 months) phases. […] The IWG does not use the term “refractory” anymore because of the declining rate of splenectomy.

• #66 How we treat primary immune thrombocytopenia in adults | Journal of Hematology & Oncology | Full Text

  https://jhoonline.biomedcentral.com/articles/10.1186/s13045-023-01401-z

  The presence of anti-GP autoantibodies is helpful to confirm the diagnosis of immune thrombocytopenia, while it cannot distinguish the primary from the secondary ITP. […] It should be emphasized that the response to treatments, especially intravenous immunoglobulin (IVIg), is of great value for the confirmation of ITP diagnosis. […] Therefore, it is critical to re-evaluate the diagnosis during the course of the disease, especially in patients who respond poorly to treatment and cases with new symptoms, signs, and new laboratory findings. […] According to the disease duration, ITP can be divided into newly diagnosed (<3 months), persistent (3–12 months), and chronic (>12 months) phases. […] The IWG does not use the term “refractory” anymore because of the declining rate of splenectomy.

• #67 How we treat primary immune thrombocytopenia in adults | Journal of Hematology & Oncology | Full Text

  https://jhoonline.biomedcentral.com/articles/10.1186/s13045-023-01401-z

  The presence of anti-GP autoantibodies is helpful to confirm the diagnosis of immune thrombocytopenia, while it cannot distinguish the primary from the secondary ITP. […] It should be emphasized that the response to treatments, especially intravenous immunoglobulin (IVIg), is of great value for the confirmation of ITP diagnosis. […] Therefore, it is critical to re-evaluate the diagnosis during the course of the disease, especially in patients who respond poorly to treatment and cases with new symptoms, signs, and new laboratory findings. […] According to the disease duration, ITP can be divided into newly diagnosed (<3 months), persistent (3–12 months), and chronic (>12 months) phases. […] The IWG does not use the term “refractory” anymore because of the declining rate of splenectomy.

• #68 Immune Thrombocytopenia (ITP): Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/5726-immune-thrombocytopenia

  Immune thrombocytopenia (ITP) is a rare blood disorder that affects how your blood clots. […] Immune thrombocytopenia (ITP) is a form of low platelet count, a condition that keeps your blood from clotting. […] Immune thrombocytopenia happens when your immune system clears your platelets from circulation and your platelet level goes down. […] Healthcare providers classify ITP by the amount of time you’ve had the condition: Acute ITP, which usually goes away within three months. […] How is immune thrombocytopenia diagnosed? […] Before making a diagnosis, your healthcare provider will do a physical exam to check for bleeding on or under your skin. […] Providers may do the following tests: Complete blood count (CBC). […] If you’re at risk for HIV, hepatitis C or H. pylori, your provider may do tests for those infections.

• #69 How we treat primary immune thrombocytopenia in adults | Journal of Hematology & Oncology | Full Text

  https://jhoonline.biomedcentral.com/articles/10.1186/s13045-023-01401-z

  The presence of anti-GP autoantibodies is helpful to confirm the diagnosis of immune thrombocytopenia, while it cannot distinguish the primary from the secondary ITP. […] It should be emphasized that the response to treatments, especially intravenous immunoglobulin (IVIg), is of great value for the confirmation of ITP diagnosis. […] Therefore, it is critical to re-evaluate the diagnosis during the course of the disease, especially in patients who respond poorly to treatment and cases with new symptoms, signs, and new laboratory findings. […] According to the disease duration, ITP can be divided into newly diagnosed (<3 months), persistent (3–12 months), and chronic (>12 months) phases. […] The IWG does not use the term “refractory” anymore because of the declining rate of splenectomy.

• #70 Understanding Your ITP Diagnosis | PDSA

  https://pdsa.org/what-is-itp

  How is ITP diagnosed? ITP is a diagnosis of exclusion. Because there is no definitive test to diagnose ITP, your doctor will rule out other causes of low platelets, such as an underlying illness or medications you or your child may be taking. If no other cause is found, the diagnosis is often ITP. […] In addition to asking about your or your child’s medical history, your doctor will perform a physical exam and run one or more of the following tests: […] Complete blood count (CBC): A common blood test used to determine the number of blood cells, including platelets, in a sample of blood. […] Blood smear: This test is used to confirm the number of platelets observed in a complete blood count. […] Bone marrow exam: If blood tests show your platelet count is low, a bone marrow test may be recommended to show whether your bone marrow is making enough platelets; the American Society of Hematology doesn’t recommend this test for children with ITP. […] Learn more about the tests used to diagnose ITP and important information to share with your doctor for the correct diagnosis.

• #71 Immune thrombocytopenia (ITP) | disease | symptoms | Sobi

  https://www.sobi.com/en/sobi-itp-immune-thrombocytopenia

  ITP is identified by a diagnosis of exclusion. There is no single blood test that can prove whether a patient has ITP, so it has to be a process of eliminating other possible causes based on a patients history, on examinations, and on the results of initial tests. In diagnosing ITP, the healthcare provider will carry out blood tests to identify the underlying causes of low platelets. ITP is diagnosed if blood tests show that only the platelet count is low while the platelets, red blood cells and white blood cells all look normal. […] In cases of persistent ITP, a bone marrow biopsy may be recommended to rule out other causes for a reduced platelet count. A small sample of bone marrow is taken under local anaesthetic and examined under the microscope. If the bone marrow is free from abnormalities and other blood tests are normal, then chronic ITP will be diagnosed.

• #72 Understanding Your ITP Diagnosis | PDSA

  https://pdsa.org/what-is-itp

  How is ITP diagnosed? ITP is a diagnosis of exclusion. Because there is no definitive test to diagnose ITP, your doctor will rule out other causes of low platelets, such as an underlying illness or medications you or your child may be taking. If no other cause is found, the diagnosis is often ITP. […] In addition to asking about your or your child’s medical history, your doctor will perform a physical exam and run one or more of the following tests: […] Complete blood count (CBC): A common blood test used to determine the number of blood cells, including platelets, in a sample of blood. […] Blood smear: This test is used to confirm the number of platelets observed in a complete blood count. […] Bone marrow exam: If blood tests show your platelet count is low, a bone marrow test may be recommended to show whether your bone marrow is making enough platelets; the American Society of Hematology doesn’t recommend this test for children with ITP. […] Learn more about the tests used to diagnose ITP and important information to share with your doctor for the correct diagnosis.

• #73 Immune thrombocytopenic purpura (ITP) | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/idiopathic-thrombocytopenic-purpura-itp

  Immune thrombocytopenic purpura (ITP) is a rare autoimmune disorder that causes you to have low platelet levels. […] ITP is diagnosis of exclusion once a low platelet count has been discovered, more tests are used to rule out any other causes. […] These tests may include: blood tests such as a full blood examination (FBE) to check for platelet numbers, to see if there are abnormalities in other blood counts, or to see if the blood cells look normal under the microscope. […] In addition to these tests, doctors diagnose ITP by taking the persons medical history and doing a physical examination.

• #74 How we treat primary immune thrombocytopenia in adults | Journal of Hematology & Oncology | Full Text

  https://jhoonline.biomedcentral.com/articles/10.1186/s13045-023-01401-z

  The presence of anti-GP autoantibodies is helpful to confirm the diagnosis of immune thrombocytopenia, while it cannot distinguish the primary from the secondary ITP. […] It should be emphasized that the response to treatments, especially intravenous immunoglobulin (IVIg), is of great value for the confirmation of ITP diagnosis. […] Therefore, it is critical to re-evaluate the diagnosis during the course of the disease, especially in patients who respond poorly to treatment and cases with new symptoms, signs, and new laboratory findings. […] According to the disease duration, ITP can be divided into newly diagnosed (<3 months), persistent (3–12 months), and chronic (>12 months) phases. […] The IWG does not use the term “refractory” anymore because of the declining rate of splenectomy.

• #75 Orphanet: Immune thrombocytopenia

  https://www.orpha.net/en/disease/detail/3002

  A presumptive diagnosis is made when the history, physical examination, complete blood count and examination of the peripheral blood smear do not suggest other etiologies for the thrombocytopenia. […] There is no 'gold standard’ test that can reliably establish the diagnosis. […] A positive response to intravenous immunoglobulin (IVIg) and/or steroids is supportive of the diagnosis. […] In ITP the bone marrow is normal, and bone marrow aspiration is indicated mainly in patients over 60 years’ of age, in case of anomalies of other cell lines, when thrombocytopenia is refractory to first-line treatments, or when other diagnoses are suspected such as myelodysplastic syndromes (MDS). […] In addition to the morphologic assessment, cytogenetic testing should be considered if an MDS is suspected.

• #76 Immune Thrombocytopenic Purpura (ITP) – CLL Society

  https://cllsociety.org/cll-sll-patient-education-toolkit/immune-thrombocytopenic-purpura-itp/

  When a low platelet count is discovered, it is critical that autoimmune disease be ruled out as the cause before considering what the treatment should be. This is because both progression of the cancer and autoimmune disease can result in low platelet counts, and treatments for each can be very different. […] In severe cases of ITP (where platelet counts drop to critical levels of less than 10 x 109/L), treatment may be necessary before the suspected diagnosis can be confirmed with a bone marrow biopsy or other tests. How the body responds to an ITP-specific treatment prior to testing may help to either confirm or rule out the diagnosis of ITP.

• #77

  https://journals.lww.com/bloodcoagulation/fulltext/2022/09000/primary_immune_thrombocytopenia__a__diagnosis_of.1.aspx

  Current diagnosis of primary immune thrombocytopenia (ITP) is presumptive, centered on excluding other causes of thrombocytopenia. […] The diagnosis of ITP is challenging because of the wide range of potential inherited and acquired causes of thrombocytopenia. […] We did not identify a diagnostic test that clinicians can use to confirm the diagnosis of ITP. […] In the absence of a diagnostic test of proven value in ITP, the clinician is best served by a comprehensive history and physical examination, complete blood count and review of the peripheral blood smear in evaluating thrombocytopenia. […] Devoid of a definitive confirmatory test, it is difficult to reliably establish the diagnosis without excluding congenital and acquired causes. […] Since the original description by Harrington and James W. Hollingsworth in 1950, there has been no significant advancement made in the diagnostic criteria, despite the fact that rapid strides have been made in the management of ITP.

• #78 Immune Thrombocytopenia Resources | Foundation for Women & Girls with Blood Disorders

  https://www.fwgbd.org/resources/immune-thrombocytopenia-resources

  Immune thrombocytopenia (ITP) is a debilitating autoimmune disorder characterized by increased platelet destruction and reduction in blood platelets, resulting in an increased incidence of bleeding. […] Recent research conducted by the American Society of Hematology (ASH) indicates that providers, especially those outside hematology, may have knowledge and practice gaps with regard to appropriate diagnosis of ITP, given there is no specific clinical test to confirm a suspected diagnosis. In fact, research suggests that one in 7 patients suspected of having primary ITP was misdiagnosed at some point during their disease course; 56.1% had grade 2 bleeding (Arnold, 2017). […] ASH recently revised its 2011 evidence-based guidelines for treatment and management of ITP. The 2019 guidelines focus on determining the optimal treatment protocol and second-line agents where necessary, in an effort to avoid treatments that have little evidence of success and may have detrimental side effects that outweigh possible benefits.

• #79 Immune Thrombocytopenia Resources | Foundation for Women & Girls with Blood Disorders

  https://www.fwgbd.org/resources/immune-thrombocytopenia-resources

  To help providers better understand the revisions in these recommendations, FWGBD recently hosted a state-of-the-science webinar on Addressing the Management of ITP: An Introduction and Review of the Most Recent ASH 2019 Clinical Practice Guidelines for ITP. The webinar will review the evidence-based recommendations and guidelines covering the management of ITP. […] Successful treatment of ITP involves open communication and support between providers and patients in order to help patients navigate the burden of managing their disease and enhance their quality of life.

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