Abstract

Immune thrombocytopenia currently called under its’ new name, immune thrombocytopenic purpura (ITP) is a disease characterized by thrombocytopenia, in which the body attacks its own platelets due to the disorders in immune system. The pathophysiology of this disease includes increased platelet destruction and most megakaryocyte production in bone marrow. The most common clinical manifestation of ITP is mild or severe progressive bleeding that could result in death. ITP is generally named as primary or secondary ITP according to thrombocytopenia severity, disease duration, bleeding status and secondary occurrence of the disease. Currently for diagnosis, despite the blood count, antiglobulin test and laboratory tests that can detect platelet-bound antibodies, they are not enough for definitive diagnosis. Like the difficulty in diagnosis, ITP treatment is quite complicated which varies depending on age, characteristics and risk of the patient. It is classified as first, second and third-line treatment options. Also, depending on the condition of patients, combined treatment might be an option which increases the complexity of the treatment. Unfortunately, discussions related to different clinical applications in diagnosis and treatments continue recently. For this reason, we considered that preparation of a review containing recent updates in diagnostic approaches and treatment options in ITP will be remarkable and beneficial for physicians interested in this subject.

Highlights

  • Platelets are the smallest shaped elements of the blood that play a primary role in preventing bleeding

  • One of the most common diseases associated with platelets is immune thrombocytopenia (ITP), an autoimmune disease, formerly called immune thrombocytopenic purpura

  • The pathophysiology of ITP is not yet fully understood, most important point is considered to be the production of antiplatelet auto-antibodies

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Summary

Introduction

Platelets are the smallest shaped elements of the blood that play a primary role in preventing bleeding. In ITP, the immune system marks the surface antigens of platelets as foreign for an unknown reason This situation leads to opsonization and disintegration of platelets in the organs (reticuloendothelial system) that form the body's defense mechanism, especially the spleen [1,2,3]. The cause of platelet destruction is the formation of auto-antibodies targeting glycoprotein IIb/IIIa on the surface of the platelets, which occurs when immune system loses its tolerance to its platelet antigens. Marking platelets with these auto-antibodies causes them to be destroyed by macrophages or cytotoxic T cells. The most serious bleeding is intracranial hemorrhage, which can cause stroke and death

General Approaches and Classification in ITP
Drugs and pregnancy
Laboratory Methods Used in ITP Diagnosis
Quantitative immunoglobulins
Treatment Options of ITP
Intravenous Immunoglobulin
Thrombopoietin Receptor Agonists
Criteria for Confirming ITP Diagnosis and Treatment
Findings
Significance of Platelet Membrane Glycoprotein
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