Immune Thrombocytopenic Purpura Presenting Research Articles

Immune Thrombocytopenic Purpura Presenting with Pituitary Apoplexy: A Case Report and Literature Review.

Background Pituitary apoplexy is a rare condition that usually occurs in the setting of a pituitary adenoma. It can present with symptoms of visual disturbances, vertigo, headache, and neurological impairments. Computed tomography (CT) scans can aid in identifying pituitary apoplexy and ruling out other diseases. We present a unique case of pituitary apoplexy in the setting of immune thrombocytopenic purpura (ITP). Case Description A 61-year-old man with a past medical history significant for myocardial infarction presented to the emergency department with symptoms of diplopia and headache 36 hours after onset. The patient was found to have severe thrombocytopenia with a platelet count below 20,000. A CT of the head revealed a possible pituitary adenoma with compression of the optic chiasm. The patient's platelet count continued to decrease throughout his admission and dropped below 7,000 on day 2 of admission. The patient was given platelet transfusion along with intravenous immunoglobulins. The patient underwent endoscopic transsphenoidal resection of the pituitary mass. Pathology of the mass revealed immature platelets characteristic of immune ITP in the setting of pituitary apoplexy. Conclusion While ITP in the setting of pituitary apoplexy is a rare entity, we believe that clinicians should have pituitary apoplexy on their differential diagnosis in patients with ITP.

Immune Thrombocytopenic Purpura presenting as paraneoplastic syndrome in a Dedifferentiated Liposarcoma: A case report

Introduction: Immune thrombocytopenia (ITP) is an autoimmune bleeding disorder characterized by isolated low platelet counts, that occurs because of increased platelet destruction by the production of autoantibodies against platelet antigens. ITP secondary to solid neoplasia is rare. The treatment consists of pharmacological treatment to improve thrombocytopenia and the treatment of the underlying malignancy. Case Report: A 72-year-old woman was admitted in the emergency department with petechial lesions and spontaneous ecchymosis with about three weeks of evolution. Analytically confirmed severe thrombocytopenia, without anemia and normal leukogram, and positive direct antigliadin test, admitting thrombocytopenic purpura. In the subsequent etiological study, a nodular formation was identified in the right para renal area, later biopsied confirming the diagnosis of dedifferentiated retroperitoneal liposarcoma. Despite an initial favorable response to corticosteroid therapy, there was persistence of low platelet count despite first-line therapy (corticosteroids and immunoglobulin), with the need to associate second-line drugs (rituximab and Eltrombopag). There was remission of ITP after complete tumor excision. Conclusion: The association of immune thrombocytopenia with dedifferentiated liposarcoma is very rare, with only one previous case described in the medical literature. The treatment of an underlying malignancy may lead to resolution of thrombocytopenia, which is why, although the association of ITP with solid tumors is very uncommon, it is important to screen for solid tumor in the etiological study of ITP. KEYWORDS Immune thrombocytopenia, dedifferentiated retroperitoneal liposarcoma, paraneoplastic syndrome.

Immune thrombocytopenic purpura in a child with mucopolysaccharidoses

Hematological manifestations in mucopolysaccharidoses (MPS) are relatively rare. We report a rare presentation of immune thrombocytopenic purpura with recurrent mucosal bleeds in a 5-year-old boy with MPS.

Immune thrombocytopenic purpura presenting in a patient after renal transplant for diabetic nephropathy

BackgroundImmune thrombocytopenic purpura (ITP) is primarily characterized by immune-mediated destruction of platelets in circulation. Major treatment options range from careful observation, steroids, immunosuppressive medications, immunoglobulins to splenectomy. Interestingly and rarely, ITP has also been reported after solid organ transplantation in patients receiving immunosuppressive medications. While the incidence of new onset ITP after solid organ transplant is comparatively well documented, new onset ITP after renal transplant has only been reported in two patients. Both these patients underwent renal transplant for underlying Immunoglobulin-A (IgA) nephropathy and were treated effectively with steroids. We present successful management of the first reported case of new-onset ITP presenting after renal transplant in a patient with underlying diabetic nephropathy. The case report discusses the potential management strategies in such a novel scenario aiming simultaneously for a well-functioning renal graft, adequate hemostasis, minimum therapy- related morbidity and least cost implications for the patient.Case PresentationA 43-year-old male with hypertension and diabetes mellitus (DM), complicated by nephropathy and retinopathy, underwent pre-emptive living related renal transplant by donation from his 33-year-old wife. His immediate post-transplant period was unremarkable. Six months after the transplant, he presented with isolated thrombocytopenia. An extensive workup revealed no clinical or laboratory evidence of unusual substance intake, infection, hemolysis, microangiopathy, autoimmune disease or hematological malignancy. Eight months after the transplant, while the patient was maintained on steroids, cellcept and tacrolimus, his platelet count dipped to 13,000/microL and he had an episode of mild epistaxis. He was administered steroids in line with the adult ITP management protocol. Steroids were well tolerated, and platelet counts showed a good response to therapy. Steroids were then successfully tapered over the next ten weeks with steady and acceptable platelet counts and graft function.ConclusionsThe case report discusses the diagnostic considerations and successful management of new-onset post-renal transplant ITP. It also highlights the various therapeutic options available in the medical armamentarium including shuffling of immunosuppressive drugs, rituximab, thrombopoietin receptor agonists (TPO’s) and splenectomy for their potential use in complicated scenarios like relapsing, or steroid-refractory post renal transplant ITP.

Immune thrombocytopenic purpura presenting as unprovoked gingival hemorrhage: a case report.

Immune thrombocytopenic purpura is an autoimmune disease characterized by auto-antibody induced platelet destruction and reduced platelet production, leading to low blood platelet count. In this case report, the clinical diagnose of a patient with immune thrombocytopenic purpura and spontaneous gingival hemorrhage by a dentist is presented. The patient did not have any systemic disease that would cause any spontaneous hemorrhage. The patient was referred to a hematologist urgently and her thrombocyte number was found to be 2000/μL. Other test results were in normal range and immune thrombocytopenic purpura diagnose was verified. Then hematological treatment was performed and patient’s health improved without further problems. Hematologic diseases like immune thrombocytopenic purpura, in some cases may appear firstly in the oral cavity and dentists must be conscious of unexplained gingival hemorrhage. In addition, the dental treatment of immune thrombocytopenic purpura patients must be planned with a hematologist.

A case of immune thrombocytopenic purpura presenting with intracranial hemorrhage

Immune thrombocytopenic purpura is an acute, generally considered a self-limiting benign disorder with a 60%-80% change of spontaneous recovery occurring usually within a few months after onset. Intracranial hemorrhage is a rare but life-threatening complication of childhood immune thrombocytopenic purpura. We report a 4-year-old girl who admitted with headache, vomiting, bleeding from noise and bruises on the extremities. Her neurological examination was normal. Based on laboratory finding she was diagnosed immune thrombocytopenic purpura and intracranial hemorrhage. We suggest that cranial imaging should be perform in patients with immune thrombocytopenic purpura admitted with bleeding symptoms, vomiting and headache even if they had no abnormal neurological signs.

Splenic artery embolization in the management of an acute immune thrombocytopenic purpura–related intracranial hemorrhage

Although relatively rare, intracranial hemorrhage remains the most common cause of immune thrombocytopenic purpura–related mortality [Medeiros D. Current controversies in the management of idiopathic thrombocytopenic purpura during childhood. Pediatr Clin North Am. 1996;43:757-72]. The required decompressive treatment has the potential for substantial blood loss and must often be delayed because of resistant thrombocytopenia responsive only to splenectomy. Splenic embolization is a novel approach to this problem that can expedite definitive neurosurgical care and minimize permanent sequelae. This is the first reported case of splenic embolization in the management of a child with known immune thrombocytopenic purpura presenting with central nervous system bleeding.

A case of immune thrombocytopenic purpura presenting with recurrent intracranial hemorrhage

A case of immune thrombocytopenic purpura presenting with recurrent intracranial hemorrhage