Primary immune thrombocytopenia （ITP） is the most common hemorrhagic disorder characterized byisolated thrombocytopenia in the absence of conditions known to cause thrombocytopenia. The incidence rate of ITP is simi...Primary immune thrombocytopenia （ITP） is the most common hemorrhagic disorder characterized byisolated thrombocytopenia in the absence of conditions known to cause thrombocytopenia. The incidence rate of ITP is similar in males and females; the incidence was significantly higher among patients older than 60 years） The clinical manifestation of bleeding varies with patient. The severity of bleeding ranges from mild mucocutanous bleeding （petechiae and ecchymoses） to life-threatening hemorrhages （intracranial or gastrointestinal bleeding）; some patients have no bleeding manifestations. Fatal and major nonfatal hemorrhages were extremely higher in patients older than 60 years old.2 The thrombocytopenia in ITP has been traditionally thought to be caused by the production of autoantibodyies targeting platelet antigens. Autoantibodies attach to the platelets and are destructed by macrophages in the reticuloendothelial system. Understanding of the mechanisms of thrombocytopenia in ITP has greatly expanded in recent years. The pathogenesis of ITP is heterogeneous and complex. The thrombocytopenia in ITP is caused not only by increased platelet destruction but also by impaired platelet production. The advances in the understanding of ITP have led to the development of a novel nonimmunologic therapeutic approach by stimulating platelet production and even revised guidelines in the diagnosis and treatment of ITE3 In the process of exploring the pathogenesis of ITP, the researchers from all over the world have done a lot of studies. This review will provide an insight into the pathogenesis-oriented treatment of ITP, mainly focusing on the studies of Chinese researchers.展开更多
BACKGROUND Primary immune thrombocytopenia(ITP) is a rare autoimmune disease associated with a high bleeding risk. For those patients with gastric cancer, surgical treatment may be the only option for therapy. Here, w...BACKGROUND Primary immune thrombocytopenia(ITP) is a rare autoimmune disease associated with a high bleeding risk. For those patients with gastric cancer, surgical treatment may be the only option for therapy. Here, we present the first case of gastric cancer with severe and medically refractory ITP treated by radical resection of the gastric cancer and splenectomy. CASE SUMMARY A 54-year-old female patient was admitted to our surgical department with a 2 mo history of decreased appetite, nausea, vomiting, and weight loss, which progressed to difficulty in feeding 3 d prior to her visit. According to her medical history, she was diagnosed with refractory ITP [platelets(PLT), 3000-8000/μL] 10 years ago. After admission, the patient underwent a splenectomy and a distal subtotal gastrectomy(D2 radical resection) with Roux-en-Y reconstruction simultaneously. She had an uneventful postoperative course with a slight increase in her PLT count. This case is unique in terms of the patient's complication of severe and medically refractory ITP.CONCLUSION Simultaneous splenectomy, preoperative PLT transfusion, and early enteral nutrition were important treatment methods for helping this patient recover.展开更多
Background:Recombinant human thrombopoietin(rh-TPO)and eltrombopag are two distinct TPO receptor agonists(TPO-RAs)with different mechanisms.During the pandemic,when immunosuppressive medications are controversial,swit...Background:Recombinant human thrombopoietin(rh-TPO)and eltrombopag are two distinct TPO receptor agonists(TPO-RAs)with different mechanisms.During the pandemic,when immunosuppressive medications are controversial,switching to another TPO-RA may be worth exploring in patients who do not benefit from their first TPO-RA.We investigated the outcomes of switching from rh-TPO to eltrombopag or vice versa in immune thrombocytopenia(ITP)patients.Methods:This prospective,open-label,observational investigation included 96 adult ITP patients who needed to switch between rh-TPO and eltrombopag between January 2020 and January 2021 at Peking University People’s Hospital in China.The study evaluated response rates and platelet counts at different time points after the switch,bleeding events,time to response,duration of response,and adverse events.Results:At 6 weeks after switching,response was observed in 21/49 patients(43%)who switched for inefficacy and 34/47 patients(72%)who switched for non-efficacy-related issues.In the inefficacy group,9/27 patients(33%)responded to eltrombopag,and 12/22 patients(55%)responded to rh-TPO.In the non-efficacy-related group,21/26(81%)and 13/21(62%)patients in the eltrombopag and rh-TPO groups maintained their response rates at 6 weeks after switching,respectively.Response at 6 months was achieved in 24/49 patients(49%)switching for inefficacy and 37/47 patients(79%)switching for non-efficacy issues.In the inefficacy group,13/27 patients(48%)responded to eltrombopag,and 11/22 patients(50%)responded to rh-TPO.In the non-efficacy-related group,22/26 patients(85%)and 15/21 patients(71%)in the eltrombopag and rh-TPO groups maintained their response rates at 6 months after switching,respectively.Both eltrombopag and rh-TPO were well tolerated.Conclusions:Our study confirmed the safety and effectiveness of switching between rh-TPO and eltrombopag for ITP patients who had no response to or experienced adverse events with their first TPO-RA.When the switch was motivated by other reasons,including patient preference and platelet count fluctuations,the probability of response was high.Registration:ClinicalTrials.gov,NCT04214951.展开更多
文摘Primary immune thrombocytopenia （ITP） is the most common hemorrhagic disorder characterized byisolated thrombocytopenia in the absence of conditions known to cause thrombocytopenia. The incidence rate of ITP is similar in males and females; the incidence was significantly higher among patients older than 60 years） The clinical manifestation of bleeding varies with patient. The severity of bleeding ranges from mild mucocutanous bleeding （petechiae and ecchymoses） to life-threatening hemorrhages （intracranial or gastrointestinal bleeding）; some patients have no bleeding manifestations. Fatal and major nonfatal hemorrhages were extremely higher in patients older than 60 years old.2 The thrombocytopenia in ITP has been traditionally thought to be caused by the production of autoantibodyies targeting platelet antigens. Autoantibodies attach to the platelets and are destructed by macrophages in the reticuloendothelial system. Understanding of the mechanisms of thrombocytopenia in ITP has greatly expanded in recent years. The pathogenesis of ITP is heterogeneous and complex. The thrombocytopenia in ITP is caused not only by increased platelet destruction but also by impaired platelet production. The advances in the understanding of ITP have led to the development of a novel nonimmunologic therapeutic approach by stimulating platelet production and even revised guidelines in the diagnosis and treatment of ITE3 In the process of exploring the pathogenesis of ITP, the researchers from all over the world have done a lot of studies. This review will provide an insight into the pathogenesis-oriented treatment of ITP, mainly focusing on the studies of Chinese researchers.
文摘BACKGROUND Primary immune thrombocytopenia(ITP) is a rare autoimmune disease associated with a high bleeding risk. For those patients with gastric cancer, surgical treatment may be the only option for therapy. Here, we present the first case of gastric cancer with severe and medically refractory ITP treated by radical resection of the gastric cancer and splenectomy. CASE SUMMARY A 54-year-old female patient was admitted to our surgical department with a 2 mo history of decreased appetite, nausea, vomiting, and weight loss, which progressed to difficulty in feeding 3 d prior to her visit. According to her medical history, she was diagnosed with refractory ITP [platelets(PLT), 3000-8000/μL] 10 years ago. After admission, the patient underwent a splenectomy and a distal subtotal gastrectomy(D2 radical resection) with Roux-en-Y reconstruction simultaneously. She had an uneventful postoperative course with a slight increase in her PLT count. This case is unique in terms of the patient's complication of severe and medically refractory ITP.CONCLUSION Simultaneous splenectomy, preoperative PLT transfusion, and early enteral nutrition were important treatment methods for helping this patient recover.
基金Beijing Natural Science Foundation(No.H2018206423)National Natural Science Foundation of China(No.81970113)+1 种基金Key Program of National Natural Science Foundation of China(No.81730004)National Key Research and Development Program of China(No.2017YFA0105503)。
文摘Background:Recombinant human thrombopoietin(rh-TPO)and eltrombopag are two distinct TPO receptor agonists(TPO-RAs)with different mechanisms.During the pandemic,when immunosuppressive medications are controversial,switching to another TPO-RA may be worth exploring in patients who do not benefit from their first TPO-RA.We investigated the outcomes of switching from rh-TPO to eltrombopag or vice versa in immune thrombocytopenia(ITP)patients.Methods:This prospective,open-label,observational investigation included 96 adult ITP patients who needed to switch between rh-TPO and eltrombopag between January 2020 and January 2021 at Peking University People’s Hospital in China.The study evaluated response rates and platelet counts at different time points after the switch,bleeding events,time to response,duration of response,and adverse events.Results:At 6 weeks after switching,response was observed in 21/49 patients(43%)who switched for inefficacy and 34/47 patients(72%)who switched for non-efficacy-related issues.In the inefficacy group,9/27 patients(33%)responded to eltrombopag,and 12/22 patients(55%)responded to rh-TPO.In the non-efficacy-related group,21/26(81%)and 13/21(62%)patients in the eltrombopag and rh-TPO groups maintained their response rates at 6 weeks after switching,respectively.Response at 6 months was achieved in 24/49 patients(49%)switching for inefficacy and 37/47 patients(79%)switching for non-efficacy issues.In the inefficacy group,13/27 patients(48%)responded to eltrombopag,and 11/22 patients(50%)responded to rh-TPO.In the non-efficacy-related group,22/26 patients(85%)and 15/21 patients(71%)in the eltrombopag and rh-TPO groups maintained their response rates at 6 months after switching,respectively.Both eltrombopag and rh-TPO were well tolerated.Conclusions:Our study confirmed the safety and effectiveness of switching between rh-TPO and eltrombopag for ITP patients who had no response to or experienced adverse events with their first TPO-RA.When the switch was motivated by other reasons,including patient preference and platelet count fluctuations,the probability of response was high.Registration:ClinicalTrials.gov,NCT04214951.
