[Autoimmune thrombocytopenias].
Primary immune thrombocytopenic purpura is a hematological disorder for which appropriate diagnosis and treatment strategies are uncertain. Usually, it has a benign course associated to anti-platelet antibodies. Diagnosis is established from an acquired peripheral thrombocytopenia after ruling out drug or viral casualties. A larger auto-immune disease such as systemic lupus erythematous must be also excluded. Below 20 x 10(9) platelets/L however therapy is required but the choice between glucocorticoid and/or intravenous immunoglobulins (IVIg) remains controversial. IVIg allow a faster response than glucocorticoids but are more expensive. From 20 to 50 x 10(9) platelets/L, the choice between specific therapy and abstention is also matter of controversy. Above 50 x 10(9) platelets/L, no therapy is provided. For children, PTIP is often spontaneously resolutive. In contrast, adults often present a chronic course; if platelet count is less than 50 x 10(9)/L, splenectomy is warranted.
Lefrère
F
F
Service d'hématologie adultes Hôpital Necker 75743 Paris. francois.lefrere@nck.ap-hop-paris.fr
D000328:Adult; D002648:Child; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D016756:Immunoglobulins, Intravenous; D010976:Platelet Count; D011379:Prognosis; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000276:immunology* / Q000628:therapy; D012075:Remission, Spontaneous; D013156:Splenectomy
D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous