Diagnosis of primary immune thrombocytopenia (ITP)
1, At least 2 laboratory tests with reduced platelet count and no abnormal blood cell morphology.
2, The spleen is usually not enlarged.
3, Bone marrow examination: increased or normal megakaryocyte count, with maturation disorders.
4.Exclude other secondary thrombocytopenia, such as: pseudo-thrombocytopenia, congenital thrombocytopenia, autoimmune disease, thyroid disease, drug-induced thrombocytopenia, etc. Xiaowei Hu, Department of Hematology, The First Hospital of Soochow University
Special laboratory tests for the diagnosis of ITP.
1. Platelet membrane antigen-specific autoantibody detection: The MAIPA method has high specificity for detecting antigen-specific autoantibodies, which can distinguish immune from non-immune thrombocytopenia and contribute to the diagnosis of ITP. However, the experimental method has yet to be standardized.
2, platelet thrombopoietin (TPO) can identify reduced platelet production (elevated TPO levels) and increased platelet destruction (normal TPO), thus helping to distinguish ITP from atypical remitting or hypoproliferative MDS.
3. H. pylori testing, HIV, HCV
Staging of ITP.
1, newly diagnosed ITP: refers to patients with ITP within 3 months after diagnosis.
2, persistent ITP: refers to ITP patients with persistent thrombocytopenia 3 to 12 months after diagnosis. This includes patients without spontaneous remission or patients who cannot maintain complete remission after stopping treatment.
3.Chronic ITP: Patients with ITP whose thrombocytopenia has persisted for more than 12 months.
4.Severe ITP: refers to platelets <10×109/L and the presence of bleeding symptoms requiring treatment at the time of consultation or new bleeding symptoms occurring during conventional treatment and requiring treatment with other platelet-elevating drugs or increasing the drug dose of existing treatment.
5. Refractory ITP: Patients who meet all three of the following conditions.
(i) The splenectomy is ineffective or recurrent;
②Treatment is still needed to reduce the risk of bleeding;
③Excluding other causes of thrombocytopenia, the diagnosis of ITP is confirmed.
Treatment of ITP.
1. First-line treatment.
①Adrenal glucocorticoids: high-dose dexamethasone or prednisone
② gammaglobulin
2.Second-line treatment.
①Splenectomy
② drug therapy: azathioprine; cyclosporine A; danazol; anti-CD20 monoclonal antibody (melphalan); TPO and its receptor agonists; vincristine
Criteria for evaluating the efficacy of ITP.
1, complete response (CR): platelet count ≥ 100×109/L after treatment and no bleeding.
2, effective (R): platelet count ≥ 30×109/L and at least twofold increase over basal platelet count after treatment, and no bleeding.
3.Not effective (NR): platelet count < 30×109/L after treatment or platelet count increased less than twice the basal value or there was bleeding.
4. In defining CR or R, at least two tests should be performed with at least 7 days interval between them.