Prospective screening of 205 patients with ITP, including diagnosis, serological markers, and the relationship between platelet counts, endogenous thrombopoietin, and circulating antithrombopoietin antibodies

Abstract

Immune thrombocytopenia purpura (ITP) is characterized by destruction of circulating platelets and the presence of antiplatelet antibodies. Many of the current immunomodulatory therapies act by reducing platelet destruction and usually do not have a lasting effect. This prospective, exploratory study characterized patients with ITP by identifying their demographic and comorbid clinical factors, use of treatments, serologic markers of autoimmunity, and possible relationships between platelet counts, concentrations of endogenous thrombopoietin (eTPO), and the presence of circulating anti-TPO antibodies. Data including medical history and laboratory evaluations were collected at a single patient visit on 205 patients (19 children, 186 adults). Reported histories revealed a 5% rate of thrombotic/ischemic events. Autoimmune markers including direct antiglobulin test and antinuclear antibodies were found more frequently than in the normal population; antiplatelet antibody testing was not done. eTPO concentrations were comparable to concentrations found in healthy volunteers. Our study confirmed that no significant inverse correlation occurred between circulating concentrations of eTPO and platelet counts in patients with ITP (Spearman r = -0.15). Two of the 205 patients tested (1%) had neutralizing activity of recombinant human TPO in a biological assay; however, this activity was confirmed to be anti-TPO antibody in only 1 patient. Am.

Splenectomy and the incidence of venous thromboembolism and sepsis in patients with immune thrombocytopenia

“…Because smaller studies have suggested ITP itself to be a risk factor for thromboembolic events, 23,[35][36][37] it is possible that patients with more severe ITP, rather than the splenectomy, are at higher risk for VTE. Data from the Danish National Patient Registry 38 indicated that the adjusted odds ratio for VTE in splenectomized patients was For personal use only.…”

Safety and efficacy of eltrombopag for treatment of chronic immune thrombocytopenia: results of the long-term, open-label EXTEND study

“…[29][30][31][32][33] Studies with different therapies that increase platelets in these patients through various mechanisms have reported TEEs, including IVIg, 34 corticosteroids, 35 anti-CD40 ligand, 36 and other TPO-R agonists. 37 Approximately 3% of patients had experienced TEEs before entering the eltrombopag ITP trials.…”

Differential diagnosis of thrombocytopenes

“…Анализ данных литературы и наш многолетний опыт ведения пациентов с тром-боцитопенией позволили разработать протокол дифференциальной диагностики пациентов с тром-боцитопенией [14][15][16][17][18][19].…”