1 / 19

IMMUNE THROMBOCYTOPENIA

IMMUNE THROMBOCYTOPENIA. Cathy Payne MSN, ACNP-BC Hematology/Oncology Nurse Practitioner Ironwood Cancer and Research Centers. OBJECTIVES. • Define ITP • Terminology • Epidemiology • Mortality/Morbidity • Pathophysiology • Diagnosis • ASH guidelines/Management.

clio
Download Presentation

IMMUNE THROMBOCYTOPENIA

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. IMMUNE THROMBOCYTOPENIA Cathy Payne MSN, ACNP-BC Hematology/Oncology Nurse Practitioner Ironwood Cancer and Research Centers

  2. OBJECTIVES • Define ITP • Terminology • Epidemiology • Mortality/Morbidity • Pathophysiology • Diagnosis • ASH guidelines/Management

  3. Immune Thrombocytopenia • ITP is an autoimmune-mediated hematologic disorder, in which the patients immune system produces antibodies directed against platelet antigens resulting in immune mediated platelet destruction and/or suppression of platelet production • Cines, D.B., Blanchet, VS, (2002) Immune thrombocytopenia purpura.

  4. PATHOPHYSIOLOGY • reduced platelet lifespan due to antibody mediated destruction, as well as impaired platelet production • specific IgG autoantibodies produced by the patient’s B cells most often are directed against • platelet membrane glycoproteins like GPIIb/IIIa inciting events- viral infections and systemic conditions, malignancies

  5. TERMINOLOGY • Diagnostic platelet count <100,000 • Primary vs secondary • Duration • Severity • Refractory ITP • Response to treatment

  6. EPIDEMIOLOGY • 1 to 3 per 100,000 adults • Young women • Incidence increases with age with a slight male predominance

  7. MORBIDITY/MORTALITY • Most patients will have good outcomes with infrequent hospital admissions and no excess mortality compared with the general population • patients with persistent severe thrombocytopenia not responding to therapy within first 2 years have considerable M/M • Bleeding/infections cause of death

  8. DIAGNOSING ITP • HISTORY • ethanol history • liver disease • drug history • bleeding/bruising • family history • risk factors for HIV or hepatitis C and or B symptoms • Symptoms of MDS • autoimmune disorders • recent viral infection • history of transfusions

  9. PHYSICAL EXAM • petechiae • purpura • conjunctival bleeding • retinal hemorrhages • lesions on mucosal membranes • enlarged liver or spleen • lymph nodes • sighs of sepsis, DIC or other severe systemic abnormalities • pregnancy

  10. COMPLETE BLOOD COUNT • Isolated thrombocytopenia, plt count < 100,000 • anemia only if significant bleeding otherwise normal red cell indices, WBC count and differential, normal coagulation parameters • peripheral blood smear- schistocytes

  11. LAB TESTS • HIV and Hep C • coagulation studies • Helicobacter pylori • thyroid funtion • rheumatological studies • Vitamin B12 and folate levels • anti-platelet antibody testing- NO

  12. BONE MARROW EXAM • not always needed, but do if the etiology of thrombocytopenia is unclear • any abnormality with History/Physical, blood smear or blood indices • yes for those older than 60 years

  13. DIFFERENTIAL DIAGNOSIS • drug induced • infections • liver disease and hypersplenism • microangiopathic processes • MDS and other bone marrow disorders • vasculiticpurpura

  14. ASH GUIDELINES/MANAGEMENT OF ITP INITIAL MANAGEMENT • consider treatment for patients with a platelet count <30,000 • longer courses of corticosteroids are preferred over shorter courses of corticosteriods or IVIG • IVIG may be used in conjunction with corticosteriods if a more rapid increase in platelet count is required • either IVIG (1g.kg for one dose, repeated as necessary) or anti-D (in appropriate patients) may be used as a first line treatment if corticosteriods are contraindicated

  15. ASH GUIDELINES FOR SENCOND LINE THERAPY • splenectomy • rituximab • thrombopoientin receptor agonist • high dose dexamethasone • immunosuppression

More Related