Presentation
In the present report, we present a case with chronic HCV infection in which autoimmune thrombocytopenia developed at week 7 of PEG-IFN alpha 2b plus ribavirin therapy. The patient subsequently received ursodeoxycholic acid (UDCA) treatment. [ncbi.nlm.nih.gov]
Patients with chronic autoimmune thrombocytopenia typically present with petechiae and mucosa bleeding. Symptoms may be present for months, or some patients may experience more acute manifestations. [asmscience.org]
Entire Body System
- Inflammation
Inflamm Bowel Dis, 15 (2009), pp. 63-87 [3] L. Higuchi, S. Joffe, E. Neufeld, S. Weisdorf, J. Rosh, S. Murch, et al. Inflammatory bowel disease associated with immune thrombocytopenic purpura in children. [analesdepediatria.org]
Inflamm Bowel Dis 10 (5): 698–700 PubMed CrossRef Google Scholar McMinn JR Jr, Cohen S, Moore J, Lilly S, Parkhurst J, Tarantino MD, Terrell DR, George JN (2003) Complete recovery from refractory immune thrombocytopenic purpura in three patients treated [link.springer.com]
[…] intravascular coagulation is responsible for a further 10–15% of cases, nearly always in babies who are very ill, particularly in association with perinatal asphyxia and infection. 14, 15, 17 Thrombosis or platelet activation/immobilisation at sites of inflammation—for [fn.bmj.com]
- Congestive Heart Failure
This manifestation was the cause of rapidly progressive congestive heart failure and, together with the unusual occurrence of autoimmune thrombocytopenia, led to difficult patient care with a significantly negative influence on the outcome. [ncbi.nlm.nih.gov]
Cardiopulmonary disease including: History of coronary artery disease, angina pectoris or congestive heart failure. LV ejection fraction less than 40 percent by 2D echocardiogram. [clinicaltrials.gov]
- Disability
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Patients often have symptoms for several years before the correct diagnosis is made, and this delay in treatment may cause damage to major organs and result in permanent disability [ 5 ]. [journals.plos.org]
- Infectious Mononucleosis
mononucleosis, cytomegalovirus infection, or dengue) Disseminated intravascular coagulation Sepsis Thrombocytopenia in acute respiratory distress syndrome Thrombotic thrombocytopenic purpura–hemolytic-uremic syndrome Dilution Massive red blood cell replacement [merckmanuals.com]
Hematological
- Easy Bruising
A decrease in platelets can result in easy bruising, bleeding gums, and internal bleeding. ITP may be acute and resolve in less than 6 months, or chronic and last longer than 6 months. [hopkinsmedicine.org]
The low platelet count causes easy bruising and bleeding, which may be seen as purple areas in the skin, mucous membranes, and outer linings of organs. [icd10data.com]
A hereditary cause is suspected if there is a lifelong history of easy bruising; bleeding after tooth extractions, surgery, childbirth, or circumcision; or heavy menstruation. [merckmanuals.com]
A decrease in platelets can result in easy bruising, bleeding gums and internal bleeding. "Idiopathic" means the cause is unknown. "Thrombocytopenia" means a decreased number of platelets in the blood. [chop.edu]
Gastrointestinal
- Diarrhea
Hemolytic uremic syndrome is thrombotic thrombocytopenic purpura found in children presenting with acute renal failure, bloody diarrhea, and/or abdominal pain. [aafp.org]
[…] abnormality with decreased levels of ADAMS TS 13 in congenital TTP (Upshaw-Shülman syndrome), abnormal complement regulatory proteins such as factor H, factor I, or membrane cofactor protein, either from mutations or autoantibodies, in congenital or acquired diarrhea-associated [cancertherapyadvisor.com]
Cardiovascular
- Heart Failure
This manifestation was the cause of rapidly progressive congestive heart failure and, together with the unusual occurrence of autoimmune thrombocytopenia, led to difficult patient care with a significantly negative influence on the outcome. [ncbi.nlm.nih.gov]
Cardiopulmonary disease including: History of coronary artery disease, angina pectoris or congestive heart failure. LV ejection fraction less than 40 percent by 2D echocardiogram. [clinicaltrials.gov]
Skin
- Petechiae
Patients with chronic autoimmune thrombocytopenia typically present with petechiae and mucosa bleeding. Symptoms may be present for months, or some patients may experience more acute manifestations. [asmscience.org]
People may have tiny purple spots on their skin (petechiae) and bleed easily. Diagnosis is with blood tests to measure the number of platelets. Corticosteroids or other drugs are given to block the destruction of platelets. [merckmanuals.com]
CASE REPORT: A 70-year-old woman was admitted with rectal bleeding accompanied by widespread petechiae, bruising, tongue and buccal mucosa bleeding, and epistaxes and proved refractory to HLA- and HPA-matched PLTs. [ncbi.nlm.nih.gov]
- Eczema
Veien NK (2010): Bullous pemphigoid masquerading as recurrent vesicular hand eczema. Acta Derm Venereol 90: 4–5., 10 10. Malik M, Gürcan HM & Ahmed AR (2010): Coexistence of mucous membrane pemphigoid and connective-tissue disease. [peertechz.com]
Psychiatrical
- Withdrawn
When danazol therapy is used, glucocorticoids can be substantially reduced in dosage or withdrawn. Danazol is a good alternative to splenectomy in elderly persons, especially in women. [annals.org]
Anti CD20 antibody, Rituximab (Rituxan) reduces IgG antibody production and is frequently used as second line therapy, i.e. if the individual’s platelet count falls after corticosteroids are tapered and withdrawn. [rarediseases.org]
Face, Head & Neck
- Epistaxis
Treatment-related complications included transient hemorrhagic cystitis (1 patient), vaginal bleeding (2 patients), gastrointestinal bleeding (1 patient), epistaxis (1 patient), and antibiotic-responsive febrile neutropenia (all patients). [ncbi.nlm.nih.gov]
In March 2003 the patient received high doses IVIg but during that treatment, aggravation of the haemorrhagic diathesis with epistaxis, menorrhea and secondary anaemia (Hb 8.2 g/dl) was observed. [springerlink.com]
Severe: – Bleeding episodes—menorrhagia, epistaxis, melena—requiring transfusion or hospitalization - Symptoms interfering seriously with the quality of life 1/25/2015 Idiopathic Thrombocytopenic Purpura Prof.Dr. [slideshare.net]
In the early stages of pregnancy there is generally no need to treat ITP unless the platelet count drops below 10,000-20,000/ul, or there is associated minor bleeding such as epistaxis and bruising. [cancertherapyadvisor.com]
Therefore, our goal is to ameliorate the petechiae and nosebleeds (epistaxis) and not necessarily get one’s hemostatic platelet count up to 100,000. [hopkinsarthritis.org]
Neurologic
- Seizure
Heredity (the condition is passed down from a parent) Exposure to toxic chemicals Taking certain medications, such as certain antibiotics, cardiovascular drugs, and seizure medications Drinking too much alcohol What are the symptoms of thrombocytopenia [my.clevelandclinic.org]
Examples of medicines that may cause this to happen include quinine; antibiotics that contain sulfa; and some medicines for seizures, such as Dilantin,® vancomycin, and rifampin. [nhlbi.nih.gov]
[…] leukemia (CLL) Drug-induced immune thrombocytopenia Sepsis, a severe bacterial infection in your blood Helicobacter pylori (H. pylori), a bacteria that can live in your digestive system Medicines Medication side effects, including drugs for heart problems, seizures [webmd.com]
- Confusion
NAIT should not be confused with neonatal autoimmune thrombocytopenia. Neonatal autoimmune thrombocytopenia occurs in mothers with immune thrombocytopenia (ITP) or lupus. [verywell.com]
Medicines A reaction to medicine can confuse your body and cause it to destroy its platelets. [nhlbi.nih.gov]
Workup
[…] future reference, as corticosteroids can change marrow morphology Biopsy is performed before splenectomy to evaluate for possible hypoplasia or fibrosis Unresponsiveness to standard treatment after 6 months is an indication for bone marrow aspiration See Workup [emedicine.medscape.com]
Serum
- Cytopenia
In contrast, patients developing autoimmune cytopenias during follow-up did not appear to differ significantly from those who did not. [ncbi.nlm.nih.gov]
Bussel Fetal and neonatal cytopenias: what have we learned? [29.] C. Kaplan Neonatal alloimmune thrombocytopenia [ [ [ [33.] J. Kjeldsen-Kragh, M. Kim, M.K. Killie, A. Husebekk, J. Freedman, J.W. [apcontinuada.com]
Robak T, Robak P (2004) Treatment options for autoimmune cytopenias. Transfus Med Hemother 31:332–340 CrossRef Google Scholar 4. [springerlink.com]
- Decreased Platelet Count
Additional laboratory evaluation should be performed as clinically indicated, and a trial of discontinuing agents known to decrease platelet counts is recommended. [aafp.org]
The resulting shortened life span of platelets in the circulation, together with incomplete compensation by increased platelet production by bone marrow megakaryocytes, results in a decreased platelet count. [emedicine.medscape.com]
Treatment
Conservative methods of treatment using steroids, dietotherapy, antibiotics or immunosuppressive agents are not particularly effective in treating fistulas. [ncbi.nlm.nih.gov]
Prognosis
Prognosis • Severe bleeding is rare ( 20. [slideshare.net]
Immune thrombocytopenia (ITP) in adults: Initial treatment and prognosis. https://www.uptodate.com/contents/search. Accessed March 13, 2019. George JN, et al. [mayoclinic.org]
Although there is no known cause of ITP and there is no cure, the prognosis for a child with ITP is very good. Usually, the body stops making the antibodies that are attacking the platelets and the disorder resolves on its own. [chop.edu]
Therefore, patients suffering from B-CLL in association with ITP should have a personalized treatment program. 87 Any association of NHL and ITP which changes the prognosis of the patients should be studied carefully. [haematologica.org]
Secondary idiopathic thrombocytopenic purpura Secondary ITP due to other autoimmune or viral processes has a prognosis directly related to the underlying disorder. [cancertherapyadvisor.com]
Etiology
A greater understanding of the pathogenesis and treatment options can only be definitively clarified by analyses of settings such as the present case, as autoimmune thrombocytopenia is uncommon in patients with malignant lymphoma and the etiology and [ncbi.nlm.nih.gov]
Common Etiologies of Thrombocytopenia with Clinical Findings and Suggested Treatment Etiology Severity Clinical presentation Evaluation Treatment Comments Bone marrow suppression by irradiation, chemotherapy, or neoplasia Moderate to severe History of [aafp.org]
In addition to the platelet count, other values included in the CBC can help point to underlying etiology. [cancertherapyadvisor.com]
Epidemiology
Loftus EV, Sandborn WJ (2002) Epidemiology of inflammatory bowel disease. Gastroenterol Clin N Am 31: 1 – 20. ]. [peertechz.com]
Epidemiology of incident immune thrombocytopenia: a nationwide population-based study in France. Blood. 2014 Nov 20. 124(22):3308-15. [Medline]. Danese MD, Lindquist K, Gleeson M, Deuson R, Mikhael J. [emedicine.medscape.com]
In fact, the decision to define as ITP a platelet count between 100 × 10 9 /l and 150 × 10 9 /l in an otherwise healthy individual is not supported by recent epidemiological studies. [journals.plos.org]
"Epidemiology of immune thrombocytopenic purpura in the General Practice Research Database". Br. J. Haematol. 145 (2): 235–44. doi : 10.1111/j.1365-2141.2009.07615.x. PMID 19245432. ^ a b Roback et al. AABB Technical Manual, 16th Ed. [en.wikipedia.org]
EDTA-dependent pseudothrombocytopaenia: a 12-month epidemiological study. Scand J Clin Lab Invest. 1988;48(6):537–542. 18. Sane DC, Damaraju LV, Topol EJ, et al. [aafp.org]
Pathophysiology
This book provides a concise yet comprehensive summary of the current state of knowledge concerning the pathophysiology, differential diagnosis and treatment options that support day-to-day patient management. [books.google.com]
HCV-associated thrombocytopenia may be considered complex and multifactorial in origin, since different mechanisms have been implicated in its pathophysiology. [ncbi.nlm.nih.gov]
ITP (Pathophysiology)(cont.) skperdon.hubpages.com 1/25/2015 Idiopathic Thrombocytopenic Purpura Prof.Dr. Saad S Al Ani Khorfakkan Hospital 7 8. [slideshare.net]
Prevention
The National Heart, Lung, and Blood Institute (NHLBI) leads or sponsors many studies aimed at preventing, diagnosing, and treating heart, lung, blood, and sleep disorders. [nhlbi.nih.gov]
Bleeding can be prevented if the platelet count can be kept above 10,000 microL. [ncbi.nlm.nih.gov]
IVIG may be administered to the mother during the pregnancy or platelet transfusion may be given to the developing fetus to prevent severe bleeding. Cesarean section is recommended for delivery to prevent bleeding. Thanks for your feedback! [verywell.com]
The enlarged spleen traps platelets and prevent them from circulating in the bloodstream. [my.clevelandclinic.org]