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Present-day problems of diagnosis and treatment in the idiopathic thrombocytopenic purpura
Insights
This review covers chronic idiopathic thrombocytopenic purpura (ITP), detailing its causes, diagnosis using Karpatkin criteria, and treatment outcomes for 188 patients.
Area of Science:
- Hematology
- Immunology
Background:
- Idiopathic thrombocytopenic purpura (ITP) is a chronic autoimmune bleeding disorder.
- Understanding ITP etiology and pathogenesis is crucial for effective management.
Purpose of the Study:
- To review current literature and present clinical experience on chronic ITP.
- To analyze diagnostic criteria and therapeutic outcomes for ITP patients.
Main Methods:
- Literature review of ITP etiology, pathogenesis, diagnosis, and therapy.
- Analysis of treatment results (corticotherapy, splenectomy, platelet transfusion, immunosuppression) in 188 ITP patients (1966-1978).
- Discussion of diagnostic criteria including platelet count, bone marrow megakaryocytes, autoantibodies, and exclusion of other disorders.
Main Results:
- The study outlines mechanisms of platelet destruction in ITP.
- Karpatkin's five diagnostic criteria for ITP are discussed.
- Treatment efficacy data for corticotherapy, splenectomy, platelet transfusion, and immunosuppression are presented.
Conclusions:
- Effective management of chronic ITP requires a comprehensive approach.
- Diagnostic criteria and therapeutic strategies significantly impact patient outcomes.
- Further research into targeted immunosuppressive therapies for ITP is warranted.
Abstract:
A review is made of the data in the literature and of the authors' experience regarding the etiology and pathogenesis, diagnosis and therapy of the chronic form of idiopathic thrombocytopenic purpura (ITP). The mechanisms of production (after McMillan et al.) are presented schematically and the five criteria of ITP diagnosis suggested by Karpatkin are discussed: 1) decreased blood platelet count with direct or indirect signs of thrombocytolysis; 2) increased number of megakaryocytes in the bone marrow and/or signs of intramedullary thrombocytolysis; 3) direct or indirect signs of antiplatelet autoantibody presence in the plasma; 4) exclusion of a primary disorder and 5) absence of splenomegaly. The results of corticotherapy, splenectomy, platelet transfusion and immunosuppression (including "target" immunosuppressive therapy) in 188 patients with ITP, admitted to the clinic of Hematology--Bucharest between 1966 and 1978, are presented and analysed.