Immune thrombocytopenia (ITP)

Cooper N, Ghanima W. Immune Thrombocytopenia. N Engl J Med. 2019 Sep 5;381(10): 945-955. doi: 10.1056/NEJMcp1810479.

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Immune thrombocytopenia (ITP) is an autoimmune disease characterized by isolated thrombocytopenia. Patients may be asymptomatic at presentation or they may present with mild mucocutaneous to life-threatening bleeding. Although only 5% of patients with ITP present with severe bleeding, [1] bleeding leading to hospital admission within 5 years after diagnosis develops in approximately 15%. [2] Irrespective of bleeding problems, patients with ITP often report fatigue and impaired health-related quality of life. [3] The risk of venous thromboembolism is twice as high among patients with ITP as among persons in the general population; the management of venous thromboembolism may be especially problematic given the concomitant risk of bleeding. [4]

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Heparin-induced thrombocytopenia (HIT): The use of platelet transfusion

One of the topics of discussion this week was the utilization of platelet transfusions in patients with heparin-induced thrombocytopenia.

Goel R, et al. Platelet transfusions in platelet consumptive disorders are associated with arterial thrombosis and in-hospital mortality. Blood. 2015 Feb 26;125(9):1470-6.

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While platelets are primary mediators of hemostasis, there is emerging evidence to show that they may also mediate pathologic thrombogenesis. Little data are available on risks and benefits associated with platelet transfusions in thrombotic thrombocytopenic purpura (TTP), heparin-induced thrombocytopenia (HIT) and immune thrombocytopenic purpura (ITP). This study utilized the Nationwide Inpatient Sample to evaluate the current in-hospital platelet transfusion practices and their association with arterial/venous thrombosis, acute myocardial infarction (AMI), stroke, and in-hospital mortality over 5 years (2007-2011). Age and gender-adjusted odds ratios (adjOR) associated with platelet transfusions were calculated. There were 10 624 hospitalizations with TTP; 6332 with HIT and 79 980 with ITP. Platelet transfusions were reported in 10.1% TTP, 7.1% HIT, and 25.8% ITP admissions. Platelet transfusions in TTP were associated with higher odds of arterial thrombosis (adjOR = 5.8, 95%CI = 1.3-26.6), AMI (adjOR = 2.0, 95%CI = 1.2-3.3) and mortality (adjOR = 2.0,95%CI = 1.3-3.0), but not venous thrombosis. Platelet transfusions in HIT were associated with higher odds of arterial thrombosis (adjOR = 3.4, 95%CI = 1.2-9.5) and mortality (adjOR = 5.2, 95%CI = 2.6-10.5) but not venous thrombosis. Except for AMI, all relationships remained significant after adjusting for clinical severity and acuity. No associations were significant for ITP. Platelet transfusions are associated with higher odds of arterial thrombosis and mortality among TTP and HIT patients.

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