Trombocitopenia inmune

Abstract

Immune thrombocytopenia is a clinical condition characterized by peripheral destruction of platelets associated with a blood count below 100,000 per cubic millimeter. Mild hemorrhagic manifestations such as petechiae, ecchymosis, and gingivorrhage are the most frequent clinical presentation; however, major hemorrhagic manifestations, which are the most frequent cause of death, develop in 9.6% of adult patients with immune thrombocytopenia. These include intracranial hemorrhage, gastrointestinal bleeding, metrorrhagia, hematuria and epistaxis. Glucocorticoids are used as the first-line treatment of choice. The initial response rate to glucocorticoids ranges between 50 and 90%, but only 10 to 40% of patients maintain long-term remission. In those patients in whom an appropriate therapeutic response is not achieved, the use of an alternative secondline management such as thrombopoietin receptor agonists and rituximab present response rates ranging from 50% to more than 80%. Splenectomy is not recommended within the first year after the diagnosis of immune thrombocytopenia, except in those cases in which there are no other first-line treatment alternatives.