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https://www.readbyqxmd.com/read/28416506/clinical-updates-in-adult-immune-thrombocytopenia-itp
#1
Michele P Lambert, Terry B Gernsheimer
Immune Thrombocytopenia (ITP) occurs in 2-4:100,000 adults and results in variable bleeding symptoms and thrombocytopenia. In the last decade changes in our understanding of the pathophysiology of the disorder have led to publication of new guidelines for the diagnosis and management of ITP, and standards for terminology. Current evidence supports alternatives to splenectomy for second line management of patients with persistently low platelet counts and bleeding. Long-term follow up data suggest both efficacy and safety, in particular for the thrombopoietin receptor agonists (TPO-RA) and the occurrence of late remissions...
April 17, 2017: Blood
https://www.readbyqxmd.com/read/28395447/-quantity-of-treg-cells-and-th17-cells-in-spleen-of-primary-immune-thrombocytopenic-purpura-patients
#2
Y Y Yang, F Q Zhang, Y Pan, F Chen, M J Huang, D Y Zeng, H G Huang
Objective: To observe the quantity of Treg cells and Th17 cells in spleen of adult primary immune thrombocytopenic purpura (ITP) patients. Methods: 43 ITP cases with splenectomy treatment were enrolled from December 2008 to June 2016 at Union Hospital of Fujian Medical University, including 20 males and 23 females with a median age of 36 (18-76) years. The controls were thirty patients who underwent splenectomy because of pancreatic diseases or splenic impairment, including 21 males and 9 females with a median age of 47 (21-69) years...
March 14, 2017: Zhonghua Xue Ye Xue za Zhi, Zhonghua Xueyexue Zazhi
https://www.readbyqxmd.com/read/28295192/state-of-the-art-how-i-manage-immune-thrombocytopenia
#3
REVIEW
Nichola Cooper
The management of patients with immune thrombocytopenia (ITP) is rapidly evolving. Over the last 15 years, a number of novel treatments have improved practice, with many steroid-sparing agents and a reduction in the progression to splenectomy. Although this has improved clinical care, many therapeutic challenges remain. There is no diagnostic test, no biomarkers to direct treatment and few comparative studies to help management decisions. Development of up to date guidelines is difficult with little high-grade evidence...
April 2017: British Journal of Haematology
https://www.readbyqxmd.com/read/28208757/pathogenesis%C3%A2-and%C3%A2-therapeutic%C3%A2-mechanisms%C3%A2-in%C3%A2-immune%C3%A2-thrombocytopenia%C3%A2-itp
#4
REVIEW
Anne Zufferey, Rick Kapur, John W Semple
Immune thrombocytopenia (ITP) is a complex autoimmune disease characterized by low  platelet counts. The pathogenesis of ITP remains unclear although both antibody-mediated and/or  T cell-mediated platelet destruction are key processes. In addition, impairment of T cells, cytokine  imbalances, and the contribution of the bone marrow niche have now been recognized to be  important. Treatment strategies are aimed at the restoration of platelet counts compatible with  adequate hemostasis rather than achieving physiological platelet counts...
February 9, 2017: Journal of Clinical Medicine
https://www.readbyqxmd.com/read/28176930/length-of-stay-hospitalization-cost-and-in-hospital-mortality-in-us-adult-inpatients-with-immune-thrombocytopenic-purpura-2006-2012
#5
Ruopeng An, Peizhong Peter Wang
PURPOSE: In this study, we examined the length of stay, hospitalization cost, and risk of in-hospital mortality among US adult inpatients with immune thrombocytopenic purpura (ITP). METHODS: We analyzed nationally representative data obtained from Nationwide/National Inpatient Sample database of discharges from 2006 to 2012. RESULTS: In the US, there were an estimated 296,870 (95% confidence interval [CI]: 284,831-308,909) patient discharges recorded for ITP from 2006 to 2012, during which ITP-related hospitalizations had increased steadily by nearly 30%...
2017: Vascular Health and Risk Management
https://www.readbyqxmd.com/read/28142207/fc%C3%AE-receptor-expression-on-splenic-macrophages-in-adult-immune-thrombocytopenia
#6
S Audia, K Santegoets, A G Laarhoven, G Vidarsson, O Facy, P Ortega-Deballon, M Samson, N Janikashvili, P Saas, B Bonnotte, T R Radstake
Splenic macrophages play a key role in immune thrombocytopenia (ITP) pathogenesis by clearing opsonized platelets. Fcγ receptors (FcγR) participate in this phenomenon, but their expression on splenic macrophages and their modulation by treatment have scarcely been studied in human ITP. We aimed to compare the phenotype and function of splenic macrophages between six controls and 24 ITP patients and between ITP patients according to the treatments they received prior to splenectomy. CD86, human leucocyte antigen D-related (HLA-DR) and FcγR expression were measured by flow cytometry on splenic macrophages...
May 2017: Clinical and Experimental Immunology
https://www.readbyqxmd.com/read/28131440/-epidemiology-and-pharmacoepidemiology-of-immune-thrombocytopenia
#7
G Moulis, M Lapeyre-Mestre, D Adoue, L Sailler
During the last decade, the development of large clinical and population-based cohorts led to new findings in the epidemiology and the pharmacoepidemiology of immune thrombocytopenia (ITP). The incidence is estimated to 3-4 for 10(5) inhabitants/year, with a slight female predominance and peaks in children and patients after 60 years. The incidence rate is 9 for 10(5) inhabitants/year in males after 75 years. Variations across ethnic groups are discussed. In France, there is a North-South gradient and a peak of incidence during winter suggesting the role of viruses in ITP pathophysiology...
January 25, 2017: La Revue de Médecine Interne
https://www.readbyqxmd.com/read/28034281/is-there-any-role-for-splenectomy-in-adulthood-onset-chronic-immune-thrombocytopenia-in-the-era-of-tpo-receptors-agonists-a-critical-overview
#8
Vibor Milunovic, Inga Mandac Rogulj, Slobodanka Kolonic Ostojic
Immune thrombocytopenia (ITP) in adulthood is characterized by chronic relapsing course. Despite the efficacious first line treatment (corticosteroid, intravenous immunoglobulin), majority of patients will enter the chronic phase warranting another treatment approach. Until recently, splenectomy performed in ITP chronic phase represented the standard of care with long-term remissions in more than 70% of patients, but however has never been tested in clinical trials. However, with the advances of our understanding of ITP pathophysiology and the shifting focus on megakaryocyte impairment, novel drugs were introduced in treatment paradigm, mainly trombopoietin receptor agonists (TPO-RAs); romiplostim and eltrombopag...
December 29, 2016: Cardiovascular & Hematological Disorders Drug Targets
https://www.readbyqxmd.com/read/27981682/rituximab-in-immune-thrombocytopenia-gender-age-and-response-as-predictors-of-long-term-response
#9
Miriam Marangon, Nicola Vianelli, Francesca Palandri, Maria Gabriella Mazzucconi, Cristina Santoro, Wilma Barcellini, Bruno Fattizzo, Stefano Volpetti, Elisa Lucchini, Nicola Polverelli, Monica Carpenedo, Miriam Isola, Renato Fanin, Francesco Zaja
OBJECTIVES: To evaluate the efficacy of a salvage treatment with rituximab (RTX) in adults with primary immune thrombocytopenia (ITP), in terms of short-term response and long-term response (LTR, i.e., probability to achieve and maintain response) and to identify biological and clinical predictors of response. METHODS: We retrospectively evaluated the outcome of patients with primary ITP treated with standard dosage RTX (375 mg/m(2) × 4) as salvage therapy in five Italian centers...
December 16, 2016: European Journal of Haematology
https://www.readbyqxmd.com/read/27902998/autoimmune-cytopenias-diagnosis-management
#10
REVIEW
Christian P Nixon, Joseph D Sweeney
The autoimmune cytopenias are a related group of disorders in which differentiated hematopoietic cells are destroyed by the immune system. Single lineage disease is characterized by the production of autoantibodies against red cells (autoimmune hemolytic anemia [AIHA]), platelets (autoimmune thrombocytopenia [ITP]) and neutrophils (autoimmune neutropenia [AIN]) whereas multilineage disease may include various combinations of these conditions. Central to the genesis of this disease is the breakdown of central and/or peripheral tolerance, and the subsequent production of autoantibodies by both tissue and circulating self-reactive B lymphocytes with support from T helper lymphocytes...
December 1, 2016: Rhode Island Medical Journal
https://www.readbyqxmd.com/read/27902585/long-term-complications-of-splenectomy-in-adult-immune-thrombocytopenia
#11
Lan-Huong Thai, Matthieu Mahévas, Françoise Roudot-Thoraval, Nicolas Limal, Laetitia Languille, Guillaume Dumas, Mehdi Khellaf, Philippe Bierling, Marc Michel, Bertrand Godeau
The recent large decrease in splenectomy use for chronic immune thrombocytopenia (ITP) is partly due to still-unsolved questions about long-term safety. We performed the first single-center exposed/unexposed cohort study evaluating the long-term incidence of splenectomy complications in patients with primary ITP. Overall, 83 patients who underwent splenectomy more than 10 years ago (exposed) were matched with 83 nonsplenectomized patients (unexposed) on the date of ITP diagnosis ±5 years, age and gender. After a median follow-up of 192 months (range 0...
November 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27898556/treatment-options-in-immune-thrombocytopenia
#12
Laura Dubis, Miranda Collins
Immune thrombocytopenia (ITP) is an autoimmune condition that can cause life-threatening bleeding. ITP may develop idiopathically, after an infection or administration of a medication, or as a comorbid condition. Treatment depends on whether life-threatening, active bleeding is occurring. Although corticosteroids remain a standard of care, new medications offer patients an alternative to splenectomy when other pharmacologic treatments fail.
December 2016: JAAPA: Official Journal of the American Academy of Physician Assistants
https://www.readbyqxmd.com/read/27895357/better-outcome-of-splenectomy-in-younger-patients-suffering-from-chronic-immune-thrombocytopenia-itp
#13
Sabah Saqib, Rizwan Sultan, Hasnain Zafar
Immune thrombocytopenia purpura (ITP) may need splenectomy after failure of medical treatment. The aim of this study was to explore the outcome of splenectomy in chronic ITP and to point out factors which can predict better response to splenectomy. This retrospective chart review was conducted at the Aga Khan University Hospital, Karachi, and comprised adult patients who underwent splenectomy for ITP from October 2005 to December 2015. Of the 51 patients, 37(72.5%) were females and 14(27.5%) were males. The overall median age was 32 years (interquartile range: 18-65 years)...
October 2016: JPMA. the Journal of the Pakistan Medical Association
https://www.readbyqxmd.com/read/27876239/case-reports-of-idiopathic-thrombocytopenia-unresponsive-to-first-line-therapies-treated-with-traditional-herbal-medicines-based-on-syndrome-differentiation
#14
Juno Yang, Beom-Joon Lee, Jun-Hwan Lee
The objective of our study is to present two cases showing the effects of traditional Korean herbal medicines based on traditional Korean medicine (TKM) for the treatment of immune thrombocytopenic purpura (ITP). One patient showed no response to treatment with steroids and an immunosuppressive agent. Moreover, liver toxicity and side effects of steroids were evident. However, after he ceased conventional treatment and started to take an herbal medicine, his liver function normalized and the steroid side effects resolved...
January 2017: Explore: the Journal of Science and Healing
https://www.readbyqxmd.com/read/27851622/1988-pneumococcal-sepsis-in-itp-post-splenectomy-and-vaccination-due-to-coexisting-cvid
#15
Anusha Shanbhag, Oscar Llanos Ulloa, Nikhil Meena
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27812394/balancing-therapy-with-thrombopoietin-receptor-agonists-and-splenectomy-in-refractory-immune-thrombocytopenic-purpura-a-case-of-postsplenectomy-thrombocytosis-requiring-plateletpheresis
#16
Jacquelyn Zimmerman, Kelly J Norsworthy, Robert Brodsky
Immune thrombocytopenic purpura (ITP) causes thrombocytopenia through the autoimmune destruction of platelets. Corticosteroids remain the first line of therapy, and traditionally splenectomy has been the second. While the availability of thrombopoietin receptor agonists (TPO-RAs) has expanded treatment options, there is little data for the ideal management of these agents in preparation for splenectomy. Thrombocytosis has been reported after splenectomy in patients treated with TPO-RA preoperatively, with one prior case requiring plateletpheresis for symptomatic thrombocytosis...
2016: Case Reports in Hematology
https://www.readbyqxmd.com/read/27787747/platelet-count-evolution-as-a-predictor-of-outcome-after-splenectomy-for-immune-thrombocytopenic-purpura
#17
Moonhwan Kim, Keun Myoung Park, Woo Young Shin, Yun-Mee Choe, Keon-Young Lee, Seung-Ik Ahn
Splenectomy is the definitive second-line therapy for refractory immune thrombocytopenic purpura (ITP), and has a reported response rate of 50-80%. Medical attention should be reconsidered when there is no evidence of accessory spleen in refractory ITP patients after splenectomy. The purpose of this study was to determine whether platelet count evolution differs between patients with a successful or unsuccessful result after splenectomy for ITP. Archived records of 104 consecutive patients that underwent splenectomy for ITP were reviewed...
April 2017: International Journal of Hematology
https://www.readbyqxmd.com/read/27753191/long-term-results-of-splenectomy-in-adult-chronic-immune-thrombocytopenia
#18
Yue Guan, Shixuan Wang, Feng Xue, Xiaofan Liu, Lei Zhang, Huiyuan Li, Renchi Yang
OBJECTIVES: We performed this study in adult patients with chronic primary immune thrombocytopenia to explore the long-term efficacy and safety of splenectomy. METHODS: Data of 174 patients who underwent splenectomy in our hospital from 1994 to 2014 were analyzed. RESULTS: After splenectomy, 126 (72.4%) patients achieved a complete response (CR) and 28 (16.1%) achieved a response (R). Thirty-two (20.8%) responders relapsed with a median time of 24 months...
March 2017: European Journal of Haematology
https://www.readbyqxmd.com/read/27749769/predictive-factors-of-idiopathic-thrombocytopenic-purpura-and-long-term-survival-in-chinese-adults-undergoing-laparoscopic-splenectomy
#19
Tao Xu, Ning Li, Fa Jin, Keren Wu, Zhipeng Ye
The study aimed to investigate the long-term outcomes of laparoscopic splenectomy (LS) in Chinese patients with chronic idiopathic thrombocytopenic purpura (ITP). This was a retrospective analysis of 114 patients with ITP who underwent LS from 2001 to 2013. Patients were classified according to response at last contact: complete response (CR), partial response (PR), and no response (NR). Patients with CR had the highest platelet levels and patients with NR had the lowest. A correlation was observed between postoperative peak platelet count and platelet count on 2-month postoperative (r=0...
October 2016: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
https://www.readbyqxmd.com/read/27741009/reemergence-of-splenectomy-for-itp-second-line-treatment
#20
Charbel Chater, Louis Terriou, Alain Duhamel, David Launay, Jean P Chambon, François R Pruvot, Moshe Rogosnitzky, Philippe Zerbib
INTRODUCTION: Corticosteroids are still the standard first-line treatment for immune thrombocytopenic purpura (ITP). As second-line therapy, splenectomy and Rituximab are both recommended. The aim of our study was to compare the efficacy of Rituximab to splenectomy in persistent or chronic ITP patients. METHODS: Between January 1999 and March 2015, we retrospectively selected all consecutive patients who underwent an ITP second-line treatment: Rituximab or splenectomy...
November 2016: Annals of Surgery
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