Conditions Associated with ITP

Conditions Associated with ITP

ITP diagnostic criteria and terminology are not consistent in the medical literature. ITP can be either idiopathic primary or secondary. ITP is considered secondary when it is associated with other conditions.

Several disorders have been identified as being associated with ITP:1

  • Systemic lupus erythematosus (SLE)
    • Patients with SLE experience increased platelet clearance due to antiplatelet autoantibodies. This multifactorial process is sometimes analogous to primary ITP.2
  • HIV infection
    • Patients with HIV infection frequently develop an immunologic form of thrombocytopenia (HIV-1-ITP).3
  • Hepatitis C virus (HCV) infection
    • Patients with chronic thrombocytopenic purpura have been found to have a significantly higher prevalence of HCV versus age-matched controls.4
    • There is also some evidence that autoimmune thrombocytopenic purpura may be more common in patients with HCV infection.5
  • H. pylori infection
    • In cohorts from the US, the UK, and Italy, the prevalence of H. pylori infection among ITP patients was 46% to 47%.6 In general, H. pylori prevalence in ITP patients approximates that in the general population.7 Although the relationship between H. pylori and ITP has not been convincingly demonstrated, eradication therapy has been shown to have a valuable effect for some patients with ITP.6
  • Lymphoproliferative disorders
    • ITP may occur secondarily to malignant disorders (such as chronic lymphocytic leukemia, Hodgkin’s disease, and non-Hodgkin’s lymphoma) and nonmalignant disorders (such as autoimmune lymphoproliferative syndrome type 1 or Canale-Smith syndrome).8
  • Drug-dependent immune thrombocytopenia (DDITP): Drug-induced thrombocytopenia may, in some cases, include an antibody-mediated component. Drugs most often cited in the medical literature include quinine and sulfa-containing drugs.9,10

 

References

1. Bromberg ME. Immune thrombocytopenic purpura—the changing therapeutic landscape. New Engl J Med. 2006;355(16):1643-1645.
2. Kuwana M, Kaburaki J, Okazaki Y, Miyazaki H, Ikeda Y. Two types of autoantibody-mediated thrombocytopenia in patients with systemic lupus erythematosus. Rheumatology. 2006;45(7):851-854.
3. Li Z, Nardi MA, Karpatkin S. Role of molecular mimicry to HIV-1 peptides in HIV-1–related immunologic thrombocytopenia. Blood. 2005;106(2):572-576.
4. García-Suárez J, Burgaleta C, Hernanz N, Albarran F, Tobaruela P, Alvarez-Mon M. HCV-associated thrombocytopenia: clinical characteristics and platelet response after recombinant alpha2b-interferon therapy. Br J Haematol. 2000;110(1):98-103.
5. Panzer S, Seel E. Is there an increased frequency of autoimmune thrombocytopenia in hepatitis C infection? A review. Wien Med Wochenschr. 2003;153(19-20):417-420.
6. Stasi R, Rossi Z, Stipa E, Amadori S, Newland AC, Provan D. Helicobacter pylori eradication in the management of patients with idiopathic thrombocytopenic purpura. Am J Med. 2005;118(4):414-419.
7. Liebman HA, Stasi R. Secondary immune thrombocytopenic purpura. Curr Opin Hematol. 2007;14:557-573.
8. Bussel J. Treatment of immune thrombocytopenic purpura in adults. Semin Hematol. 2006;43(3 Suppl 5):S3-10; discussion S18-19.
9. British Committee for Standards in Haematology General Haematology Task Force. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Br J Haematol. 2003;120(4):574-596.
10. Visentin GP, Liu CY. Drug-Induced Thrombocytopenia. Hematol Oncol Clin North Am. 2007;21(4):685-696.