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. 1984 Sep;30:1829–1833.

Chronic Idiopathic Thrombocytogenic Purpura

G F Pineo
PMCID: PMC2154239  PMID: 21279099

Abstract

Chronic idiopathic thrombocytopenic purpura (ITP) is a relatively common cause of an acquired hemostatic defect. It is important for family physicians to recognize this disorder, because of its insidious onset and the fact that it most commonly affects women of childbearing age. Chronic ITP is due to an antibody in the plasma which attaches to platelets and leads to their destruction in the reticuloendothelial system. The antibody can cross the placenta and affect the fetus. Although the condition may not disappear, in the vast majority of patients it can be controlled with current therapy, including prednisone, splenectomy and immunosuppressive agents. Although the mortality rate is low, patients with severe thrombocytopenia may have significant bleeding problems requiring special measures such as platelet transfusions, intravenous gammaglobulin, plasmapheresis and emergency splenectomy. Upon diagnosis, these patients should be referred to a large, specialized centre.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adderley R. J., Rogers P. C., Shaw D., Wadsworth L. D. High-dose intravenous therapy with immune globulin before delivery for idiopathic thrombocytopenic purpura. Can Med Assoc J. 1984 Apr 1;130(7):894–896. [PMC free article] [PubMed] [Google Scholar]
  2. Ahn Y. S., Byrnes J. J., Harrington W. J., Cayer M. L., Smith D. S., Brunskill D. E., Pall L. M. The treatment of idiopathic thrombocytopenia with vinblastine-loaded platelets. N Engl J Med. 1978 May 18;298(20):1101–1107. doi: 10.1056/NEJM197805182982001. [DOI] [PubMed] [Google Scholar]
  3. Ahn Y. S., Harrington W. J., Mylvaganam R., Allen L. M., Pall L. M. Slow infusion of vinca alkaloids in the treatment of idiopathic thrombocytopenic purpura. Ann Intern Med. 1984 Feb;100(2):192–196. doi: 10.7326/0003-4819-100-2-192. [DOI] [PubMed] [Google Scholar]
  4. Ahn Y. S., Harrington W. J., Simon S. R., Mylvaganam R., Pall L. M., So A. G. Danazol for the treatment of idiopathic thrombocytopenic purpura. N Engl J Med. 1983 Jun 9;308(23):1396–1399. doi: 10.1056/NEJM198306093082306. [DOI] [PubMed] [Google Scholar]
  5. Ahn Y. S., Harrington W. J. Treatment of idiopathic thrombocytopenic purpura (ITP). Annu Rev Med. 1977;28:299–309ENG. doi: 10.1146/annurev.me.28.020177.001503. [DOI] [PubMed] [Google Scholar]
  6. Aster R. H. Platelet sequestration studies in man. Br J Haematol. 1972 Mar;22(3):259–263. doi: 10.1111/j.1365-2141.1972.tb05671.x. [DOI] [PubMed] [Google Scholar]
  7. Ayromlooi J. A new approach to the management of immunologic thrombocytopenic purpura in pregnancy. Am J Obstet Gynecol. 1978 Jan 15;130(2):235–236. doi: 10.1016/0002-9378(78)90378-2. [DOI] [PubMed] [Google Scholar]
  8. Bellone J. D., Kunicki T. J., Aster R. H. Immune thrombocytopenia associated with carcinoma. Ann Intern Med. 1983 Oct;99(4):470–472. doi: 10.7326/0003-4819-99-4-470. [DOI] [PubMed] [Google Scholar]
  9. Burns T. R., Saleem A. Idiopathic thrombocytopenic purpura. Am J Med. 1983 Dec;75(6):1001–1007. doi: 10.1016/0002-9343(83)90881-1. [DOI] [PubMed] [Google Scholar]
  10. Cines D. B., Dusak B., Tomaski A., Mennuti M., Schreiber A. D. Immune thrombocytopenic purpura and pregnancy. N Engl J Med. 1982 Apr 8;306(14):826–831. doi: 10.1056/NEJM198204083061402. [DOI] [PubMed] [Google Scholar]
  11. Crosby W. H. Editorial: Wet purpura, dry purpura. JAMA. 1975 May 19;232(7):744–745. doi: 10.1001/jama.232.7.744. [DOI] [PubMed] [Google Scholar]
  12. Davis H. H., 2nd, Varki A., Heaton W. A., Siegel B. A. Detection of accessory spleens with indium 111-labeled autologous platelets. Am J Hematol. 1980;8(1):81–86. doi: 10.1002/ajh.2830080110. [DOI] [PubMed] [Google Scholar]
  13. DiFino S. M., Lachant N. A., Kirshner J. J., Gottlieb A. J. Adult idiopathic thrombocytopenic purpura. Clinical findings and response to therapy. Am J Med. 1980 Sep;69(3):430–442. doi: 10.1016/0002-9343(80)90016-9. [DOI] [PubMed] [Google Scholar]
  14. Dixon R., Rosse W., Ebbert L. Quantitative determination of antibody in idiopathic thrombocytopenic purpura. Correlation of serum and platelet-bound antibody with clinical response. N Engl J Med. 1975 Jan 30;292(5):230–236. doi: 10.1056/NEJM197501302920503. [DOI] [PubMed] [Google Scholar]
  15. EVANS R. S., TAKAHASHI K., DUANE R. T., PAYNE R., LIU C. Primary thrombocytopenic purpura and acquired hemolytic anemia; evidence for a common etiology. AMA Arch Intern Med. 1951 Jan;87(1):48–65. doi: 10.1001/archinte.1951.03810010058005. [DOI] [PubMed] [Google Scholar]
  16. Fehr J., Hofmann V., Kappeler U. Transient reversal of thrombocytopenia in idiopathic thrombocytopenic purpura by high-dose intravenous gamma globulin. N Engl J Med. 1982 May 27;306(21):1254–1258. doi: 10.1056/NEJM198205273062102. [DOI] [PubMed] [Google Scholar]
  17. Garg S. K., Amorosi E. L., Karpatkin S. Use of the megathrombocyte as an index of megakaryocyte number. N Engl J Med. 1971 Jan 7;284(1):11–17. doi: 10.1056/NEJM197101072840103. [DOI] [PubMed] [Google Scholar]
  18. HARRINGTON W. J., SPRAGUE C. C., MINNICH V., MOORE C. V., AULVIN R. C., DUBACH R. Immunologic mechanisms in idiopathic and neonatal thrombocytopenic purpura. Ann Intern Med. 1953 Mar;38(3):433–469. doi: 10.7326/0003-4819-38-3-433. [DOI] [PubMed] [Google Scholar]
  19. HIRSCH E. O., GARDNER F. H. The transfusion of human blood platelets with a note on the transfusion of granulocytes. J Lab Clin Med. 1952 Apr;39(4):556–569. [PubMed] [Google Scholar]
  20. Harker L. A. Thrombokinetics in idiopathic thrombocytopenic purpura. Br J Haematol. 1970 Jul;19(1):95–104. doi: 10.1111/j.1365-2141.1970.tb01605.x. [DOI] [PubMed] [Google Scholar]
  21. Heyns A. D., Lötter M. G., Badenhorst P. N., van Reenen O. R., Pieters H., Minnaar P. C., Retief F. P. Kinetics, distribution and sites of destruction of 111indium-labelled human platelets. Br J Haematol. 1980 Feb;44(2):269–280. doi: 10.1111/j.1365-2141.1980.tb01209.x. [DOI] [PubMed] [Google Scholar]
  22. Hymes K., Blum M., Lackner H., Karpatkin S. Easy bruising, thrombocytopenia, and elevated platelet immunoglobulin G in Graves' disease and Hashimoto's thyroiditis. Ann Intern Med. 1981 Jan;94(1):27–30. doi: 10.7326/0003-4819-94-1-27. [DOI] [PubMed] [Google Scholar]
  23. Karpatkin S. Autoimmune thrombocytopenic purpura. Blood. 1980 Sep;56(3):329–343. [PubMed] [Google Scholar]
  24. Kelton J. G. Management of the pregnant patient with idiopathic thrombocytopenic purpura. Ann Intern Med. 1983 Dec;99(6):796–800. doi: 10.7326/0003-4819-99-6-796. [DOI] [PubMed] [Google Scholar]
  25. Kelton J. G. Management of the pregnant patient with idiopathic thrombocytopenic purpura. Ann Intern Med. 1983 Dec;99(6):796–800. doi: 10.7326/0003-4819-99-6-796. [DOI] [PubMed] [Google Scholar]
  26. Kelton J. G., Neame P. B., Gauldie J., Hirsh J. Elevated platelet-associated IgG in the thrombocytopenia of septicemia. N Engl J Med. 1979 Apr 5;300(14):760–764. doi: 10.1056/NEJM197904053001404. [DOI] [PubMed] [Google Scholar]
  27. Knodel A. R., Beekman J. F. Severe thrombocytopenia and sarcoidosis. JAMA. 1980 Jan 18;243(3):258–259. [PubMed] [Google Scholar]
  28. Marder V. J., Nusbacher J., Anderson F. W. One-year follow-up of plasma exchange therapy in 14 patients with idiopathic thrombocytopenic purpura. Transfusion. 1981 May-Jun;21(3):291–298. doi: 10.1046/j.1537-2995.1981.21381201800.x. [DOI] [PubMed] [Google Scholar]
  29. McMillan R. Chronic idiopathic thrombocytopenic purpura. N Engl J Med. 1981 May 7;304(19):1135–1147. doi: 10.1056/NEJM198105073041904. [DOI] [PubMed] [Google Scholar]
  30. McMillan R. Immune thrombocytopenia. Clin Haematol. 1983 Feb;12(1):69–88. [PubMed] [Google Scholar]
  31. McMillan R., Longmire R. L., Yelenosky R., Smith R. S., Craddock C. G. Immunoglobulin synthesis in vitro by splenic tissue in idiopathic thrombocytopenic purpura. N Engl J Med. 1972 Mar 30;286(13):681–684. doi: 10.1056/NEJM197203302861302. [DOI] [PubMed] [Google Scholar]
  32. Mueller-Eckhardt C., Kayser W., Mersch-Baumert K., Mueller-Eckhardt G., Breidenbach M., Kugel H. G., Graubner M. The clinical significance of platelet-associated IgG: a study on 298 patients with various disorders. Br J Haematol. 1980 Sep;46(1):123–131. doi: 10.1111/j.1365-2141.1980.tb05942.x. [DOI] [PubMed] [Google Scholar]
  33. ROBSON H. N., DAVIDSON L. S. P. Purpura in pregnancy with special reference to idiopathic thrombocytopenic purpura. Lancet. 1950 Jul 29;2(6622):164–169. doi: 10.1016/s0140-6736(50)91147-0. [DOI] [PubMed] [Google Scholar]
  34. Schwartz K. A., Slichter S. J., Harker L. A. Immune-mediated platelet destruction and thrombocytopenia in patients with solid tumours. Br J Haematol. 1982 May;51(1):17–24. doi: 10.1111/j.1365-2141.1982.tb07285.x. [DOI] [PubMed] [Google Scholar]
  35. Scott J. R., Cruikshank D. P., Kochenour N. K., Pitkin R. M., Warenski J. C. Fetal platelet counts in the obstetric management of immunologic thrombocytopenic purpura. Am J Obstet Gynecol. 1980 Feb 15;136(4):495–499. doi: 10.1016/0002-9378(80)90677-8. [DOI] [PubMed] [Google Scholar]
  36. Shulman N. R., Marder V. J., Weinrach R. S. Similarities between known antiplatelet antibodies and the factor responsible for thrombocytopenia in idiopathic purpura. Physiologic, serologic and isotopic studies. Ann N Y Acad Sci. 1965 Jun 30;124(2):499–542. doi: 10.1111/j.1749-6632.1965.tb18984.x. [DOI] [PubMed] [Google Scholar]
  37. Territo M., Finklestein J., Oh W., Hobel C., Kattlove H. Management of autoimmune thrombocytopenia in pregnancy and in the neonate. Obstet Gynecol. 1973 Apr;41(4):579–584. [PubMed] [Google Scholar]
  38. Verheyden C. N., Beart R. W., Jr, Clifton M. D., Phyliky R. L. Accessory splenectomy in management of recurrent idiopathic thrombocytopenic purpura. Mayo Clin Proc. 1978 Jul;53(7):442–446. [PubMed] [Google Scholar]
  39. WEISBERGER A. S., SUHRLAND L. G. Massive corticosteroid therapy in the management of resistant thrombocytopenic purpura. Am J Med Sci. 1958 Oct;236(4):425–433. [PubMed] [Google Scholar]
  40. von dem Borne A. E., Helmerhorst F. M., van Leeuwen E. F., Pegels H. G., von Riesz E., Engelfriet C. P. Autoimmune thrombocytopenia: detection of platelet autoantibodies with the suspension immunofluorescence test. Br J Haematol. 1980 Jun;45(2):319–327. doi: 10.1111/j.1365-2141.1980.tb07151.x. [DOI] [PubMed] [Google Scholar]

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