Vnitr Lek 2002, 48(8):773-780

[Diagnosis and therapy of idiopathic thrombocytopenic purpura (ITP) in adults].

L Chrobák: II. interní klinika-oddĕlení klinické hematologie FN, Hradec Králové.

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 approch 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.