FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 346:995-1008 March 28, 2002 Number 13 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

	Full Text PDF PDA Full Text Purchase this article Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited Related Article PubMed Citation

Immune thrombocytopenic purpura is an autoimmune disorder characterized by a low platelet count and mucocutaneous bleeding. The estimated incidence is 100 cases per 1 million persons per year, and about half of these cases occur in children.^1,2,3 Immune thrombocytopenic purpura is classified as primary or as secondary to an underlying disorder and as acute (of six months or less in duration) or chronic. Adult-onset and childhood-onset immune thrombocytopenic purpura are strikingly different. Affected children are young (peak age, approximately five years) and previously healthy, and they typically present with the sudden onset of petechiae or purpura a few days or . . . [Full Text of this Article]

Pathophysiology

Genetics

Diagnosis

Measuring Platelet-Associated Antibodies

Initial Management

Adults

Children

Urgent Treatment

Management of First Relapse

Adults

Children

Splenectomy

Adults

Children

Sepsis after Splenectomy

Chronic Refractory Immune Thrombocytopenic Purpura

Adults

Children

Immune Thrombocytopenic Purpura during Pregnancy

Mortality

The Patient's Perspective

The Physician's Perspective

Source Information

From the Departments of Pathology and Laboratory Medicine and of Medicine, University of Pennsylvania, Philadelphia (D.B.C.); and the Division of Haematology and Oncology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto (V.S.B.).

Address reprint requests to Dr. Cines at the Department of Pathology and Laboratory Medicine, University of Pennsylvania, 513 A Stellar-Chance, 422 Curie Blvd., Philadelphia, PA 19104, or at dcines@mail.med.upenn.edu.

References

Related Letters:

Immune Thrombocytopenic Purpura
Khouri I., Tuan B., Grant K., Bleesing J. J.H., Fleisher T. A., McCarthy L. J., Dzik W., Cines D. B., Blanchette V. S.
Extract | Full Text | PDF  
N Engl J Med 2002; 347:449-450, Aug 8, 2002. Correspondence

This article has been cited by other articles:

• Godeau, B., Porcher, R., Fain, O., Lefrere, F., Fenaux, P., Cheze, S., Vekhoff, A., Chauveheid, M.-P., Stirnemann, J., Galicier, L., Bourgeois, E., Haiat, S., Varet, B., Leporrier, M., Papo, T., Khellaf, M., Michel, M., Bierling, P. (2008). Rituximab efficacy and safety in adult splenectomy candidates with chronic immune thrombocytopenic purpura: results of a prospective multicenter phase 2 study. Blood 112: 999-1004 [Abstract] [Full Text]  
• Collin, M., Shannon, O., Bjorck, L. (2008). From the Cover: IgG glycan hydrolysis by a bacterial enzyme as a therapy against autoimmune conditions. Proc. Natl. Acad. Sci. USA 105: 4265-4270 [Abstract] [Full Text]  
• Glanz, J., France, E., Xu, S., Hayes, T., Hambidge, S. (2008). A Population-Based, Multisite Cohort Study of the Predictors of Chronic Idiopathic Thrombocytopenic Purpura in Children. Pediatrics 121: e506-e512 [Abstract] [Full Text]  
• Visco, C., Ruggeri, M., Laura Evangelista, M., Stasi, R., Zanotti, R., Giaretta, I., Ambrosetti, A., Madeo, D., Pizzolo, G., Rodeghiero, F. (2008). Impact of immune thrombocytopenia on the clinical course of chronic lymphocytic leukemia. Blood 111: 1110-1116 [Abstract] [Full Text]  
• Hereng, T., Lambert, M., Hachulla, E., Samor, M., Dubucquoi, S., Caron, C., Launay, D., Morell-Dubois, S., Queyrel, V., Hatron, P.-Y. (2008). Influence of aspirin on the clinical outcomes of 103 anti-phospholipid antibodies-positive patients. Lupus 17: 11-15 [Abstract]  
• Ruggeri, M., Fortuna, S., Rodeghiero, F. (2008). Heterogeneity of terminology and clinical definitions in adult idiopathic thrombocytopenic purpura: a critical appraisal from a systematic review of the literature. haematol 93: 98-103 [Abstract] [Full Text]  
• Dimaano, E. M., Saito, M., Honda, S., Miranda, E. A., Alonzo, M. T. G., Valerio, M. D., Mapua, C. A., Inoue, S., Kumaori, A., Matias, R., Natividad, F. F., Oishi, K. (2007). Lack of Efficacy of High-Dose Intravenous Immunoglobulin Treatment of Severe Thrombocytopenia in Patients with Secondary Dengue Virus Infection. Am J Trop Med Hyg 77: 1135-1138 [Abstract] [Full Text]  
• Berentsen, S. (2007). Rituximab for the treatment of autoimmune cytopenias. haematol 92: 1589-1596 [Full Text]  
• Bussel, J. B., Cheng, G., Saleh, M. N., Psaila, B., Kovaleva, L., Meddeb, B., Kloczko, J., Hassani, H., Mayer, B., Stone, N. L., Arning, M., Provan, D., Jenkins, J. M. (2007). Eltrombopag for the Treatment of Chronic Idiopathic Thrombocytopenic Purpura. NEJM 357: 2237-2247 [Abstract] [Full Text]  
• Schwartz, R. S. (2007). Immune Thrombocytopenic Purpura -- From Agony to Agonist. NEJM 357: 2299-2301 [Full Text]  
• Naina, H. V.K., Harris, S., Matzdorff, A. C., Cathomas, R., Goldhirsch, A., von Moos, R., Aster, R. H., Bougie, D. W. (2007). Drug-Induced Immune Thrombocytopenia. NEJM 357: 1869-1871 [Full Text]  
• Kjaersgaard, M., Aslam, R., Kim, M., Speck, E. R., Freedman, J., Stewart, D. I. H., Wiersma, E. J., Semple, J. W. (2007). Epitope specificity and isotype of monoclonal anti-D antibodies dictate their ability to inhibit phagocytosis of opsonized platelets. Blood 110: 1359-1361 [Abstract] [Full Text]  
• Franchini, M., Cruciani, M., Mengoli, C., Pizzolo, G., Veneri, D. (2007). Effect of Helicobacter pylori eradication on platelet count in idiopathic thrombocytopenic purpura: a systematic review and meta-analysis. J Antimicrob Chemother 60: 237-246 [Abstract] [Full Text]  
• Semple, J. W., Aslam, R., Kim, M., Speck, E. R., Freedman, J. (2007). Platelet-bound lipopolysaccharide enhances Fc receptor mediated phagocytosis of IgG-opsonized platelets. Blood 109: 4803-4805 [Abstract] [Full Text]  
• Sukati, H., Watson, H. G., Urbaniak, S. J., Barker, R. N. (2007). Mapping helper T-cell epitopes on platelet membrane glycoprotein IIIa in chronic autoimmune thrombocytopenic purpura. Blood 109: 4528-4538 [Abstract] [Full Text]  
• DE CASTRO, R. A. C., DE CASTRO, J.-A. A., BAREZ, M. Y. C., FRIAS, M. V., DIXIT, J., GENEREUX, M. (2007). THROMBOCYTOPENIA ASSOCIATED WITH DENGUE HEMORRHAGIC FEVER RESPONDS TO INTRAVENOUS ADMINISTRATION OF ANTI-D (RH0-D) IMMUNE GLOBULIN. Am J Trop Med Hyg 76: 737-742 [Abstract] [Full Text]  
• Deng, R., Balthasar, J. P. (2007). Comparison of the effects of antibody-coated liposomes, IVIG, and anti-RBC immunotherapy in a murine model of passive chronic immune thrombocytopenia. Blood 109: 2470-2476 [Abstract] [Full Text]  
• Mazzucconi, M. G., Fazi, P., Bernasconi, S., De Rossi, G., Leone, G., Gugliotta, L., Vianelli, N., Avvisati, G., Rodeghiero, F., Amendola, A., Baronci, C., Carbone, C., Quattrin, S., Fioritoni, G., D'Alfonso, G., Mandelli, F., for the Gruppo Italiano Malattie EMatologiche dell, (2007). Therapy with high-dose dexamethasone (HD-DXM) in previously untreated patients affected by idiopathic thrombocytopenic purpura: a GIMEMA experience. Blood 109: 1401-1407 [Abstract] [Full Text]  
• Elli, E., Parma, M., Perseghin, P., Dassi, M., Terruzzi, E., Belotti, D., Pioltelli, P., Pogliani, E.M. (2007). Successful treatment with T depleted autologous peripheral blood stem cell transplantation of refractory chronic autoimmune thrombocytopenic purpura. haematol 92: e7-e8 [Abstract] [Full Text]  
• Alving, B. M. (2006). Heparin-induced thrombocytopenia: the female factor. Blood 108: 2884-2885 [Full Text]  
• Warkentin, T. E., Sheppard, J.-A. I., Sigouin, C. S., Kohlmann, T., Eichler, P., Greinacher, A. (2006). Gender imbalance and risk factor interactions in heparin-induced thrombocytopenia. Blood 108: 2937-2941 [Abstract] [Full Text]  
• Bromberg, M. E. (2006). Immune Thrombocytopenic Purpura -- The Changing Therapeutic Landscape. NEJM 355: 1643-1645 [Full Text]  
• Kuwana, M., Kaburaki, J., Okazaki, Y., Miyazaki, H., Ikeda, Y. (2006). Two types of autoantibody-mediated thrombocytopenia in patients with systemic lupus erythematosus. Rheumatology (Oxford) 45: 851-854 [Abstract] [Full Text]  
• Kim, M. W., Choi, H. M. (2006). Fetal Hydrocephalus in a Pregnancy Complicated by Idiopathic Thrombocytopenic Purpura. J Ultrasound Med 25: 777-780 [Full Text]  
• El Fassi, D., Nielsen, C. H, Hasselbalch, H. C, Hegedus, L. (2006). The rationale for B lymphocyte depletion in Graves' disease. Monoclonal anti-CD20 antibody therapy as a novel treatment option.. Eur J Endocrinol 154: 623-632 [Abstract] [Full Text]  
• Nakamura, M., Tanaka, Y., Satoh, T., Kawai, M., Hirakata, M., Kaburaki, J., Kawakami, Y., Ikeda, Y., Kuwana, M. (2006). Autoantibody to CD40 ligand in systemic lupus erythematosus: association with thrombocytopenia but not thromboembolism. Rheumatology (Oxford) 45: 150-156 [Abstract] [Full Text]  
• Beardsley, D. S. (2006). ITP in the 21st Century. ASH Education Book 2006: 402-407 [Abstract] [Full Text]  
• Gramaglia, I., Sahlin, H., Nolan, J. P., Frangos, J. A., Intaglietta, M., van der Heyde, H. C. (2005). Cell- Rather Than Antibody-Mediated Immunity Leads to the Development of Profound Thrombocytopenia during Experimental Plasmodium berghei Malaria. J. Immunol. 175: 7699-7707 [Abstract] [Full Text]  
• Buchanan, G. R. (2005). Thrombocytopenia During Childhood:: What the Pediatrician Needs to Know. Pediatr. Rev. 26: 401-409 [Full Text]  
• Olsson, M., Bruhns, P., Frazier, W. A., Ravetch, J. V., Oldenborg, P.-A. (2005). Platelet homeostasis is regulated by platelet expression of CD47 under normal conditions and in passive immune thrombocytopenia. Blood 105: 3577-3582 [Abstract] [Full Text]  
• Linenberger, M. L., Price, T. H. (2005). Use of Cellular and Plasma Apheresis in the Critically Ill Patient: Part II: Clinical Indications and Applications. J Intensive Care Med 20: 88-103 [Abstract]  
• Solanilla, A., Pasquet, J.-M., Viallard, J.-F., Contin, C., Grosset, C., Dechanet-Merville, J., Dupouy, M., Landry, M., Belloc, F., Nurden, P., Blanco, P., Moreau, J.-F., Pellegrin, J.-L., Nurden, A. T., Ripoche, J. (2005). Platelet-associated CD154 in immune thrombocytopenic purpura. Blood 105: 215-218 [Abstract] [Full Text]  
• Davis, M. P. (2004). Hematology in palliative medicine. AM J HOSP PALLIAT CARE 21: 445-454 [Abstract]  
• Kojouri, K., Vesely, S. K., Terrell, D. R., George, J. N. (2004). Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications. Blood 104: 2623-2634 [Abstract] [Full Text]  
• Watts, R. G. (2004). Idiopathic Thrombocytopenic Purpura: A 10-Year Natural History Study at the Childrens Hospital of Alabama. CLIN PEDIATR 43: 691-702 [Abstract]  
• Motta, M, Tincani, A, Lojacono, A, Faden, D, Gorla, R, Airo, P, Neri, F, Gasparoni, A, Ciardelli, L, de Silvestri, A, Marconi, M, Chirico, G (2004). Neonatal outcome in patients with rheumatic disease. Lupus 13: 718-723 [Abstract]  
• McMillan, R., Durette, C. (2004). Long-term outcomes in adults with chronic ITP after splenectomy failure. Blood 104: 956-960 [Abstract] [Full Text]  
• Panitsas, F. P., Theodoropoulou, M., Kouraklis, A., Karakantza, M., Theodorou, G. L., Zoumbos, N. C., Maniatis, A., Mouzaki, A. (2004). Adult chronic idiopathic thrombocytopenic purpura (ITP) is the manifestation of a type-1 polarized immune response. Blood 103: 2645-2647 [Abstract] [Full Text]  
• Kuwana, M., Nomura, S., Fujimura, K., Nagasawa, T., Muto, Y., Kurata, Y., Tanaka, S., Ikeda, Y. (2004). Effect of a single injection of humanized anti-CD154 monoclonal antibody on the platelet-specific autoimmune response in patients with immune thrombocytopenic purpura. Blood 103: 1229-1236 [Abstract] [Full Text]  
• Vesely, S. K., Perdue, J. J., Rizvi, M. A., Terrell, D. R., George, J. N. (2004). Management of Adult Patients with Persistent Idiopathic Thrombocytopenic Purpura Following Splenectomy: A Systematic Review. ANN INTERN MED 140: 112-120 [Abstract] [Full Text]  
• Houwerzijl, E. J., Blom, N. R., van der Want, J. J. L., Esselink, M. T., Koornstra, J. J., Smit, J. W., Louwes, H., Vellenga, E., de Wolf, J. Th. M. (2004). Ultrastructural study shows morphologic features of apoptosis and para-apoptosis in megakaryocytes from patients with idiopathic thrombocytopenic purpura. Blood 103: 500-506 [Abstract] [Full Text]  
• Cines, D. B., Bussel, J. B., McMillan, R. B., Zehnder, J. L. (2004). Congenital and Acquired Thrombocytopenia. ASH Education Book 2004: 390-406 [Abstract] [Full Text]  
• Vasoo, S, Thumboo, J, Fong, K-Y (2003). Refractory immune thrombocytopenia in systemic lupus erythematosus: response to mycophenolate mofetil. Lupus 12: 630-632 [Abstract]  
• Kuperman, A. A., Yaniv, I., Stahl, B., Tamary, H. (2003). Methylphenidate as a possible cause of thrombocytopenia. The Annals of Pharmacotherapy 37: 1146-1146 [Full Text]  
• Kuwana, M., Kawakami, Y., Ikeda, Y. (2003). Suppression of autoreactive T-cell response to glycoprotein IIb/IIIa by blockade of CD40/CD154 interaction: implications for treatment of immune thrombocytopenic purpura. Blood 101: 621-623 [Abstract] [Full Text]  
• Veneri, D., Gottardi, M., Guizzardi, E., Zanuso, C., Krampera, M., Franchini, M., Emilia, G., Luppi, M., Morselli, M., Longo, G., Torelli, G. (2002). Idiopathic thrombocytopenic purpura, Helicobacter pylori infection, and HLA class II alleles. Blood 100: 1925-1927 [Full Text]  
• Khouri, I., Tuan, B., Grant, K., Bleesing, J. J.H., Fleisher, T. A., McCarthy, L. J., Dzik, W., Cines, D. B., Blanchette, V. S. (2002). Immune Thrombocytopenic Purpura. NEJM 347: 449-450 [Full Text]  
• Watanabe, N., Ikuta, K., Nisitani, S., Chiba, T., Honjo, T. (2002). Activation and Differentiation of Autoreactive B-1 Cells by Interleukin 10 Induce Autoimmune Hemolytic Anemia in Fas-deficient Antierythrocyte Immunoglobulin Transgenic Mice. J. Exp. Med. 196: 141-146 [Abstract] [Full Text]