Beruflich Dokumente
Kultur Dokumente
agosto 2020
DEFINICIÓN
• Desorden autoinmune caracterizado x plq bajas y sangrado
mucocutaneo.
Douglas B. Cines, N Engl J Med. 2002; 13: 995-1008.
Clinical updates in adult immune thrombocytopenia BLOOD, 25 MAY 2017 x VOLUME 129, NUMBER 21
Terminología de la ITP: 3 Fases
0 a 12 meses
PTI de
PTI persistente PTI Crónica
diagnóstico
reciente
• De exclusión
• Examen físico revela sangrado tipo plaquetario.
• Plq inmaduras (grandes)
• Atc antiplaquetarios: sensibilidad 49-66%,
especificidad 78-92%
DIAGNOSTICO
The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia
DIAGNOSTICO
• Presentación inicial
• Plq>30,000/mcl sin o con mínimo sangrado: OBS
• Plq<30, y sangrado menor: Glucocorticoides
• Plq<10, y sangrado mayor: Gluc, IgIv, transfusión plq.
The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia
MANEJO EN NIÑOS
The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia
MANEJO
How I treat immune thrombocytopenia: the choice between splenectomy or a medical therapy as a second-line treatment
MANEJO
How I treat immune thrombocytopenia: the choice between splenectomy or a medical therapy as a second-line treatment
MANEJO: TPI reciente
EMA, European Medicines Agency; FDA, US Food and Drug Administration; GRB, Growth factor receptor-bound protein; JAK, janus
kinase; MAPK, mitogen-activated protein kinase; SHC, Src homology 2 domain containing; SOS, son of sevenless; STAT, signal
transducer and activator of transcription; TPO-R, thrombopoietin receptor; 1. Erickson-Miller C et al. Stem Cells 2009;27:424; 2.
Bussel JB & Pinheiro MP. In: Hematopoietic Growth Factors in Oncology. 2011;157:289–303; 3. Kuter D et al. Seminars Hematol
2010;47:243; 4. Kuter DJ. Blood 2007;109:4607; 5. http://www.drugs.com/newdrugs/fda-approves-new-indication-promacta-
eltrombopag-severe-aplastic-anemia-4077.html (accessed April 2016); 6. https://www.novartis.com/news/media-releases/novartis-
receives-eu-approval-new-revolade%C2%AE-use-first-class-therapy-patients (accessed April 2016)
• Fostamatinib un inhibidor oral 100mg/2/dia, Inh TK esplénico
• F en 101 pac y placebo en 49 pac
• Rptas globales (>50,000) en las primeras 12 sem ocurrio en
43% de F vs 2% en placebo.
• Eventos adversos: HTA (31 vs 15%), nauseas (19 vs 8%),
debilidad (11 vs 8%) e incremento de transaminasas (11 vs
0%)
• Fostamatinib produjo respuestas sostenidas en TPI
refractarios quienes habían fallado a esplenectomía, AR-TPO,
y/o Rituximab