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Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Idiopathic,ThrombocytopeniaPurpura,（,Immune,Thrombocytopenia,）,特发性血小板减少性紫癜,Outlines,Definition,Epidemiology,Pathogenesis,Signs,and,symptoms,Laboratory,Findings,Diagnosis,Treatment,Definition,ITP,is,an,autoimmune,disease,with,antibodies,detectable,可检测,against,several,platelet,surface,antigens,血小板表面抗原,low,platelet,count,(thrombocytopenia),It,causes,a,characteristic,purpuric,rash,紫癜性皮疹,and,an,increased,tendency,to,bleed,Epidemiology,The,incidence,going,up,with,the,age,get,older,F:M,=,4:1,in,adults,male,dominant,in,children,and,senior,1.,Infection,Bacteria,virus,infection,commonly,Acute,ITP:,normally,has,upper,respiratory,infection,2-3,weeks,before,onset,Chronic,ITP:,Infection,could,be,an,induction,诱因,Pathogenesis,2.,Immunology,In,approximately,60,percent,of,cases,antibodies,against,platelets,can,be,detected.,Most,often,these,antibodies,are,against,platelet,membrane,glycoproteins,血小板膜糖蛋白,and,are,of,the,immunoglobulin,G,(IgG),type.,Normal,PLT,can,be,destructed,in,the,patient,plasma.,Immune,suppressive,drugs,is,effective,to,ITP,patients.,3.,CTL,induced,platelet,destruction,The,stimulus,for,auto-antibody,production,in,ITP,is,probably,abnormal,T,cell,activity.,Preliminary,初步,findings,suggest,that,these,T,cells,can,be,influenced,by,drugs,that,target,B,cells,such,as,rituximab,利,妥昔单抗,.,Symptoms,Signs,include,the,spontaneous,formation,of,bruises,淤青,(purpura),especially,on,the,extremities,四肢,bleeding,from,the,nostrils,鼻孔,and/or,g,ums,牙龈,and,menorrhagia,月经过多,(excessive,menstrual,bleeding,月经出血,),any,of,which,may,occur,if,the,platelet,count,is,below,20,000,per,l,.,A,very,low,count,(80%,auto-curable,Recurrent,attack,to,yrs,Laboratory,Findings,1.Platelet,count,2.Bone,morrow,examination,3.PLT,antibody:,PA,IgG,4.Evans,syndrome,Blood,count,（,x10,9,/L,）,platelets,20,mainly,30-80,WBC/RBC,Normal,Normal,Lifespan,of,PLT,BM,morphology,Laboratory,findings,Acute,ITP,Chronic,ITP,1-6,hrs,1-3,days,Hypercellularity,No,of,megakaryocytes,normal,or,increased,remarkable,Normal,of,E,G,Acute,ITP,Chronic,ITP,(Chronic,ITP,Wright,stain,x200),(Megalokaryocyte,Gimsa,stain,x400),Serum,PA,Ig,or,PA,C3,PA,Ig,G,or,M,PAC3,Evans,syndrome,ITP,with,AIHA,Diagnosis,1.,Clinical,presentations,of,bleeding,no,physical,signs,other,than,bleedings.,2.,Low,platelet,count,repeatly,3.,Despite,the,destruction,of,platelets,by,splenic,脾的,macrophages,the,spleen,is,normally,not,enlarged,4.,Megakaryocytes,in,BM,normal,or,increased,with,maturation,成熟,disorder,5.,One,of,the,following,five:,Corticosteriod,effective,Splenectomy,脾切除术,effective,PA,Ig,(+),PA,C3,(+),Lifespan,寿命,of,PLT,shortened,Classification,of,acute,ITP,or,chronic,ITP,Exclusion,of,secondary,thrombocytopenia,血小板减少,(differential,diagnosis),1.,Aplastic,anemia,再生障碍性贫血,2.,Systemic,lupus,erythematosus,系统性红斑狼疮,3.,Drug,induced,thrombocytopenia,药物,性血小板减少症,4.,Myelodysplastic,syndrome,骨髓,增生异常综合征,5.,Acute,leukemia,急性白血病,Treatment,Splenectomy,(removal,of,the,spleen),Immunosuppressive,agents,Cyclosporin,环孢素,Mycophenolate,mofetil,(MMF),骁悉,Azathioprine,硫唑嘌呤,Vincristine,长春新碱,Three,steps:,Corticosteroids,Strategy,Corticosteroids,Thrombopoietin,促血小板生成素受体,receptor,agonists,Platelet,transfusion,Except,in,an,emergency,it,is,not,recommended,and,usually,unsuccessful,in,producing,a,long-term,platelet,count,increase.,Rituximab,利,妥昔单抗,a,monoclonal,单克隆的,antibody,against,the,B,cell,surface,antigen,CD20,may,sometimes,be,an,effective,alternative,to,splenectomy.,Introvenous,immunoglobulin,（,IV,Ig,）,Thank,you,
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