Abstract
Immune thrombocytopenic purpura (ITP) is also known as idiopathic thrombocytopenic purpura. Increased platelet destruction and insufficient platelet production are both responsible for its etiopathogenesis. ITP can be diagnosed after excluding other possible causes of thrombocytopenia. One hundred forty-three cases of chronic ITP that were monitored in a hematology clinic were retrospectively evaluated. All cases received first line treatment of 1 mg/kg/day prednisolone. Corticosteroid nonresponsive (CN) cases and corticosteroid-dependent (CD) cases underwent splenectomies. The rate of CN/CD cases was found to be 53% (n=76). Sixty-six percent of these cases (n=50) underwent splenectomies. The ratio of non-responsive cases to relapse cases after splenectomy (SN/SR) was 30% (n=15). The total number of cases was 41, including those without splenectomy (n=26) and with SY/SR (n=15). Helicobacter pylori (Hp) eradication, immunosuppressive agents and danazol treatments were administered to patients (n=10, n=14 and n=4, respectively). Currently, 13 patients are being monitored without treatment. Fifteen patients who were non-responsive to Hp eradication treatment, immunosuppressive treatment or danazol treatment are still being monitored without any treatment. Optimal treatment is not available for splenectomy-resistant cases of ITP. The response rates for Hp eradication treatment, immunosuppressive treatments and anabolic agents are low. Therefore, larger studies with more patients are required using new agents, such as thrombopoietin (TPO) receptor agonists and anti-CD20 monoclonal antibodies.
Highlights
Immune thrombocytopenic purpura (ITP) is known as idiopathic thrombocytopenic purpura [1]
Helicobacter pylori (Hp) eradication, immunosuppressive agents and danazol treatments were administered to patients (n=10, n=14 and n=4, respectively)
Fifteen patients who were non-responsive to Hp eradication treatment, immunosuppressive treatment or danazol treatment are still being monitored without any treatment
Summary
Immune thrombocytopenic purpura (ITP) is known as idiopathic thrombocytopenic purpura [1]. ITP can be diagnosed after the exclusion of other diseases causing thrombocytopenia. ITP is currently described as a primary immune thrombocytopenia [2, 3]. In cases of chronic ITP, serious bleeding is not expected even with significant thrombocytopenia. The mortality rate due to bleeding secondary to ITP is less than 1% [4]. Corticosteroids are given as the first line of therapy in ITP cases with serious thrombocytopenia. Splenectomy is the standard care for cases that are non-responsive to corticosteroids. No consensus is currently available regarding the appropriate treatment of patients with serious thrombocytopenia who require treatment following the splenectomy [6]. Various post-splenectomy treatments have been administered to refractory patients. The treatment of chronic refractory ITP is difficult because response to treatment is variable. Thrombopoietin (TPO) receptor antagonists and anti-CD20 monoclonal antibodies are new treatment approaches with different mechanisms of action [8, 9]
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