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Platelet Transfusions, H. pylori Eradication, and Chemotherapy

Panelists: Howard A. Liebman, MD, USC; Keith McCrae, MD, Cleveland Clinic; Ivy Altomare, MD, Duke
Published: Thursday, May 14, 2015
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Platelet transfusions are not typically used in idiopathic thrombocytopenic purpura (ITP) and are generally reserved for acute, life-threatening bleeding, says Keith McCrae, MD. The usefulness of transfusions for patients with ITP is a debateable topic, McCrae adds.

Two concerns with transfusions include a risk of alloimmunization and a significant drop in the reestablished platelet count within 24 hours after a transfusion. Ivy Altomare, MD, describes that H pylori infection can lead to immune thrombocytopenia by a molecular memory mechanism. Amino acids on H pylori stimulate autoreactive antibodies to the glycoprotein on the receptor of platelets. These antibodies cross-react with platelets, causing immune thrombocytopenia. Data from Asia show that when the infection is treated, the autoimmune thrombocytopenia resolves, but that has not been shown in the United States population, notes Altomare.

Chemotherapy agents, such as vincristine, azathioprine, and cyclophosphamide, have been utilized in ITP management. McCrae comments that chemotherapy, while effective, is not used as frequently as it once was in this setting, because thrombopoietin receptor agonists are now available. Few randomized studies have evaluated their use in ITP, limiting the level of evidence.
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For High-Definition, Click
Platelet transfusions are not typically used in idiopathic thrombocytopenic purpura (ITP) and are generally reserved for acute, life-threatening bleeding, says Keith McCrae, MD. The usefulness of transfusions for patients with ITP is a debateable topic, McCrae adds.

Two concerns with transfusions include a risk of alloimmunization and a significant drop in the reestablished platelet count within 24 hours after a transfusion. Ivy Altomare, MD, describes that H pylori infection can lead to immune thrombocytopenia by a molecular memory mechanism. Amino acids on H pylori stimulate autoreactive antibodies to the glycoprotein on the receptor of platelets. These antibodies cross-react with platelets, causing immune thrombocytopenia. Data from Asia show that when the infection is treated, the autoimmune thrombocytopenia resolves, but that has not been shown in the United States population, notes Altomare.

Chemotherapy agents, such as vincristine, azathioprine, and cyclophosphamide, have been utilized in ITP management. McCrae comments that chemotherapy, while effective, is not used as frequently as it once was in this setting, because thrombopoietin receptor agonists are now available. Few randomized studies have evaluated their use in ITP, limiting the level of evidence.
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