Chronic immune thrombocytopenia:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia, PA
Saunders
2009
|
| Schriftenreihe: | Hematology, oncology clinics of North America
23,6 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | Includes bibliographical references and index |
| Beschreibung: | XI S., S. 1155 - 1350 Ill., graph. Darst. |
| ISBN: | 9781437712285 |
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| 245 | 1 | 0 | |a Chronic immune thrombocytopenia |c guest ed. Howard A. Liebman |
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| 300 | |a XI S., S. 1155 - 1350 |b Ill., graph. Darst. | ||
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| 490 | 1 | |a Hematology, oncology clinics of North America |v 23,6 | |
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| 650 | 4 | |a Blood platelet disorders | |
| 650 | 4 | |a Thrombocytopenia | |
| 650 | 4 | |a Purpura, Thrombocytopenic, Idiopathic | |
| 650 | 4 | |a Chronic Disease | |
| 650 | 4 | |a Blood platelet disorders | |
| 650 | 4 | |a Chronic Disease | |
| 650 | 4 | |a Purpura, Thrombocytopenic, Idiopathic | |
| 650 | 4 | |a Thrombocytopenia | |
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Datensatz im Suchindex
| _version_ | 1804140938192224256 |
|---|---|
| adam_text | Titel: Chronic immune thrombocytopenia
Autor: Liebman, Howard A.
Jahr: 2009
Chronic Immune Thrombocytopenia
Contents
Preface
Howard A. Liebman
The Immune Thrombocytopenia Syndrome: A Disorder of Diverse Pathogenesis
and Clinical Presentation 1155
Douglas B. Cines and Howard A. Liebman
This article presents a brief history of immune thrombocytopenia (ITP) from
the first clinical description written in 1735, through years of controversy
about the nature and causes of what was first known as idiopathic throm-
bocytopenia purpura, then immune thrombocytopenic purpura, and,
finally, ITP. Current understanding of ITP s primary and secondary forms
and the effect of diverse defects in immune self tolerance that result in
the development of antiplatelet antibodies is described. This overview is
followed by a narrative list of other articles in this issue on topics ranging
from a comprehensive review of the role of antiplatelet antibodies in plate-
let destruction and production to a review of classic treatment modalities
and newer approaches to initial treatment.
Antiplatelet Antibodies in Chronic ImmuneThrombocytopenia and Their Role
in Platelet Destruction and Defective Platelet Production 1163
Robert McMillan
Chronic immune thrombocytopenia (ITP) is an autoimmune disorder
manifested by immune-mediated platelet destruction and suppression
of platelet production. Chronic ITP characteristically has an insidious on-
set, usually requires therapy, and is most commonly seen in adults. The
diagnosis of chronic ITP is one of exclusion and is based on the Amer-
ican Society of Hematology Guidelines: The patient s history, physical
examination, and peripheral blood film must be consistent with the
diagnosis and other causes of thrombocytopenia must be ruled out.
This article reviews the role of antiplatelet autoantibody in adult
chronic ITP.
Infections, Antigen-Presenting Cells.T Cells, and Immune Tolerance: Their Role
in the Pathogenesis of Immune Thrombocytopenia 1177
John W. Semple
In the last 20 years, many publications have shed new light on the complex
immunopathogenesis of immune thrombocytopenic purpura. They are as-
sociated with 3 interrelated areas of environmental autoimmunity, for ex-
ample, infectious influences, antigen-presenting cell (APC) function, and
T-cell abnormalities, particularly tolerance induction. This article highlights
the recent literature and argues that infectious agents and platelets can
significantly modulate APCs, which create an environment that dysregu-
lates autoreactive T cells, leading to the production of autoantibodies.
Contents
Thrombopoietin and Platelet Production in Chronic Immune Thrombocytopenia 1193
David J. Kuter and Terry B. Gernsheimer
Since 1968, a greater understanding of platelet biology and its regulation
by thrombopoietin (TpO) has emerged. It is now recognized that immune
thrombocytopenic purpura (ITP) is a disorder of reduced platelet produc-
tion as well as increased platelet destruction. New therapies for ITP have
emerged that have exploited this new pathophysiologic understanding.
This article reviews the biology of TPO, the regulation of its circulating level
in ITP, the platelet kinetic data supporting inappropriate platelet produc-
tion in ITP, and the TPO mimetic agents available to treat ITP.
Chronic ImmuneThrombocytopenia in Adults: Epidemiology
and Clinical Presentation 1213
Patrick F. Fogarty
Data concerning the prevalence of chronic immune thrombocytopenia
(ITP) among adults are limited and are confounded by lack of concordance
of definitions of stage of disease. In the largest series of outpatients, prev-
alence has been estimated to range from 5.6 to 20 per 100,000 population
and increases with advancing age. A female predominance is most pro-
nounced among middle-aged patients, and no racial variation is apparent.
Adult patients with chronic ITP may have a better prognosis than
previously thought, although bleeding risk increases dramatically in asso-
ciation with severe thrombocytopenia and older age; a small minority of
patients may recover spontaneously. More systematic analyses, with stan-
dardized definitions of cases and adequate duration of follow up, are
needed.
Chronic ImmuneThrombocytopenia in Children: Epidemiology
and Clinical Presentation 1223
Carolyn M. Bennett and Michael Tarantino
Immune thrombocytopenic purpura (ITP) is one of the most common ac-
quired bleeding disorders in children. Most children with ITP will have
acute disease, self-limited thrombocytopenia that resolves completely
within weeks or months, with or without therapy. A small subset of children
with ITP has clinically significant disease with severe thrombocytopenia
and/or bleeding that requires intervention. Treatment for these children
is an ongoing clinical challenge, as few therapies offer long-term
remission, and all have significant side effects and toxicities. This article
focuses on the management of clinically significant chronic ITP in the pe-
diatric population.
ImmuneThrombocytopenia in Patients with Connective Tissue Disorders
and the Antiphospholipid Antibody Syndrome 1239
Daniel G. Arkfeld and llene C. Weitz
It has been theorized that immune thrombocytopenia (ITP) is a syndrome
characterized by various defects in immune regulation, resulting in a com-
mon phenotype, decreased blood platelets, and symptoms of mucocuta-
neous bleeding. Most often, successful treatment of the underlying
connective tissue disorder with corticosteroids or other disease-modifying
Contents
agents can simultaneously improve concurrent thrombocytopenia. The
best evidence to date would support the targeting of treatment to the con-
nective tissue disorder, expecting a simultaneous improvement in the
platelet count. Due to the frequent relapses associated with many of the
connective tissue disorders and the frequent use of immunosuppressant
agents, splenectomy should be undertaken only in highly refractory pa-
tients. Differentiating the varying immunopathic etiologies that contribute
to development of connective tissue disorders may lead to a better under-
standing of the mechanisms of thrombocytopenia in a subset of these pa-
tients. The use of target therapies to treat connective tissue disorders has
the potential of reducing the risk of the development of ITP or, conversely,
inducing the development of immune thrombocytopenia.
Thyroid Disease in Patients with Immune Thrombocytopenia 1251
Eric Cheung and Howard A. Liebman
The literature regarding an association between thyroid disease and im-
mune thrombocytopenic purpura (ITP) suggests that autoimmune thyroid
disease is a frequent finding in patients with ITP. A strong association be-
tween other systemic autoimmune diseases and autoimmune thyroid dis-
eases is also well documented. Therefore, the combination of autoimmune
thyroid disease and ITP could reflect a more significant defect in the im-
mune self-tolerance of these patients compared with those who have pri-
mary ITP alone. Such defects may characterize an ITP patient population
as more refractory to standard ITP therapy. Screening patients for antithy-
roid antibodies would identify a patient population at greater risk of devel-
oping overt thyroid disease. These patients may be further screened with
a thyroid-stimulating hormone assay to detect subclinical thyroid disease.
ImmuneThrombocytopenia in Lymphoproliferative Disorders 1261
Carlo Visco and Francesco Rodeghiero
Lymphoproliferative disorders are recognized as a common cause of sec-
ondary immune thrombocytopenia (ITP). The mechanisms involved in the
pathogenesis of ITP associated with lymphoproliferative disorders are het-
erogeneous and often linked to the presence and activity of the malignant
clone. A better understanding of the responsible mechanisms leading to
ITP in each disease may allow for targeted treatment decisions, avoiding
unwarranted immunosuppression and bleeding complications.
Infectious Causes of Chronic Immune Thrombocytopenia 1275
Roberto Stasi, Fenella Willis, Muriel S. Shannon,
and Edward C. Gordon-Smith
Persistent thrombocytopenia may be the consequence of chronic infec-
tions with hepatitis C virus (HCV), human immunodeficiency virus (HIV),
and Helicobacter pylori, and should be considered in the differential diag-
nosis of primary immune thrombocytopenia (ITP). Studies have shown that
on diagnosis of infections, treatment of the primary disease often results in
substantial improvement or complete recovery of the thrombocytopenia.
In patients with thrombocytopenia due to HCV-related chronic liver dis-
ease, the use of eltrombopag, a thrombopoietin receptor agonist,
Contents
normalizes platelet levels, thereby permitting the initiation of antiviral ther-
apy. Antiviral therapy with highly active antiretroviral therapy for HIV has
aided in platelet recovery, with a corresponding decrease in circulating vi-
ral load. Thrombocytopenia in the absence of other disease symptoms re-
quires screening for/-/, pylori, especially in countries such as Japan, where
there is a high prevalence of the disease and the chances of a platelet re-
sponse to eradication therapy are high.
Immune Thrombocytopenia in Pregnancy 1299
Evi Stavrou and Keith R. McCrae
Management of immune thrombocytopenia in pregnancy can be a com-
plex and challenging task and may be complicated by fetal-neonatal
thrombocytopenia. Although fetal intracranial hemorrhage is a rare compli-
cation of immune thrombocytopenia in pregnancy, invasive studies de-
signed to determine the fetal platelet count before delivery are
associated with greater risk than that of fetal intracranial hemorrhage
and are discouraged. Moreover, the risk of neonatal bleeding complica-
tions does not correlate with the mode of delivery, and cesarean section
should be reserved only for obstetric indications.
Intravenous Immunoglobulin and Anti-RhD Therapy in the Management
of ImmuneThrombocytopenia 1317
Nichola Cooper
Intravenous immunoglobulin and intravenous anti-D are common thera-
pies in the management of patients with immune thrombocytopenia
(ITP). Both are pooled plasma products and both result in an increase in
the platelet count in approximately 60% to 70% of patients with ITP. De-
spite immediate increases in the platelet count, the duration of response is
limited, with platelet increments lasting between 2 and 4 weeks. Infusion
reactions are common but adverse events rare. Although responses are
similar, human and murine data suggest that the mechanisms of action
of these treatments are complex and likely different.
Traditional and New Approaches to the Management of Immune
Thrombocytopenia: Issues of When and Who to Treat 1329
James B. Bussel
Diagnosis and management of chronic ITP requires experience and the
appropriate use of the laboratory despite the absence of a diagnostic
test for ITP. Consideration of secondary ITP is important because identifi-
cation of immunodeficiency infections or of lymphoproliferative disorders
would change the management approach to a given patient. The develop-
ment of newer therapies such as rituximab and the thrombopoietic agents
has had a major impact on the management of ITP. In the future, combina-
tions of agents may be a critical approach although the schedule and dos-
ing remains difficult to establish. Finally, current studies to augment
therapy in newly diagnosed ITP patients to prevent chronic disease may
lessen the number of patients in chronic disease category.
Index 1343
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| spelling | Chronic immune thrombocytopenia guest ed. Howard A. Liebman Philadelphia, PA Saunders 2009 XI S., S. 1155 - 1350 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Hematology, oncology clinics of North America 23,6 Includes bibliographical references and index Blood platelet disorders Thrombocytopenia Purpura, Thrombocytopenic, Idiopathic Chronic Disease Thrombozytopenie (DE-588)4124311-0 gnd rswk-swf Chronische Krankheit (DE-588)4010176-9 gnd rswk-swf Thrombozytopenie (DE-588)4124311-0 s Chronische Krankheit (DE-588)4010176-9 s DE-604 Liebman, Howard A. Sonstige oth Hematology, oncology clinics of North America 23,6 (DE-604)BV000625446 23,6 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=018804616&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Chronic immune thrombocytopenia Hematology, oncology clinics of North America Blood platelet disorders Thrombocytopenia Purpura, Thrombocytopenic, Idiopathic Chronic Disease Thrombozytopenie (DE-588)4124311-0 gnd Chronische Krankheit (DE-588)4010176-9 gnd |
| subject_GND | (DE-588)4124311-0 (DE-588)4010176-9 |
| title | Chronic immune thrombocytopenia |
| title_auth | Chronic immune thrombocytopenia |
| title_exact_search | Chronic immune thrombocytopenia |
| title_full | Chronic immune thrombocytopenia guest ed. Howard A. Liebman |
| title_fullStr | Chronic immune thrombocytopenia guest ed. Howard A. Liebman |
| title_full_unstemmed | Chronic immune thrombocytopenia guest ed. Howard A. Liebman |
| title_short | Chronic immune thrombocytopenia |
| title_sort | chronic immune thrombocytopenia |
| topic | Blood platelet disorders Thrombocytopenia Purpura, Thrombocytopenic, Idiopathic Chronic Disease Thrombozytopenie (DE-588)4124311-0 gnd Chronische Krankheit (DE-588)4010176-9 gnd |
| topic_facet | Blood platelet disorders Thrombocytopenia Purpura, Thrombocytopenic, Idiopathic Chronic Disease Thrombozytopenie Chronische Krankheit |
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