Pathophysiology and management of chronic immune thrombocytopenia: focusing on what matters
Lisa J. Toltl,
Donald M. Arnold,
Lisa J. Toltl
Department of Medicine, Michael DeGroote School of Medicine, McMaster University
Search for more papers by this authorDonald M. Arnold
Department of Medicine, Michael DeGroote School of Medicine, McMaster University
Canadian Blood Services, Hamilton, ON, Canada
Search for more papers by this authorLisa J. Toltl,
Donald M. Arnold,
Lisa J. Toltl
Department of Medicine, Michael DeGroote School of Medicine, McMaster University
Search for more papers by this authorDonald M. Arnold
Department of Medicine, Michael DeGroote School of Medicine, McMaster University
Canadian Blood Services, Hamilton, ON, Canada
Search for more papers by this authorDonald M. Arnold MD, MSc, FRCP(C), HSC 3V-48, 1200 Main Street West, Hamilton, ON, Canada. E-mail: [email protected]
Summary
Immune thrombocytopenia (ITP) is a common autoimmune disease characterized by low platelet counts and an increased risk of bleeding. Antibody-mediated platelet destruction has been the prevailing hypothesis to explain ITP pathogenesis, supported by the efficacy of B-cell depletion therapy; however, the recent success of thrombopoietin receptor agonists lends support to the notion that platelet production is also insufficient. Best practice for the management of chronic ITP has not yet been established because data from comparative trials are lacking. Despite renewed interest in novel drugs capable of increasing platelet counts, ultimate treatment goals for ITP patients must be kept in mind: to improve patients’ health and well-being. In this article, the pathophysiology of ITP is reviewed and key remaining questions about mechanism are explored. A rational approach to the management of ITP in adults is outlined, acknowledging evidence and evidence gaps, and highlighting the need for clinically important endpoints in future clinical trials.
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