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CZECH MEDICAL ASSOCIATION J. Ev. PURKYNĚ |
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Česky / Czech version | Vnitř. Lék., 48, 2002, No. 8, p. 773 - 780 |
Diagnosis and Therapy of Idiopathic Thrombocytopenic Purpura (ITP) of
Adults Chrobák L. II. interní klinika - oddělení klinické hematologie FN, Hradec Králové, přednosta prof.MUDr. Jaroslav Malý, CSc. |
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Summary: Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder resulting from the binding
of antibodies directed toward platelet surface glycoproteins GP IIb/IIIa and GP Ib/IX leading
to their clearance by reticuloendothelial system. The diagnosis of ITP is made clinically by exclusion
of other causes of thrombocytopenia. The treatment of chronic ITP is palliative, not curative
and is directed toward inactivation and removal of a major site of platelet destruction and antibody
production represented by the spleen. Spontaneous remission of ITP in adults are very rare.
The goal of treatment for ITP is to prevent serious bleeding. About 30 % of the affected patients
show a long term response to steroid therapy. Splenectomy is the treatment of choice in the
remaining patients. The treatment of patients refractory to corticosteroid therapy and splenectomy
remains largely empirical and to date a generally accepted therapy has not been established.
The newest approche to the treatment involves the use of monoclonal antibodies. In intracranial
bleeding and in severe bleeding in refractory ITP use of rVIIa has been shown to might be useful.
ITP in pregnancy represent a special situation. There is the trend toward treating these patients
in a more conservative fashion.
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