Revised: November 21, 2013
Accepted: December 13, 2013
Published online: March 27, 2014
Immune thrombocytopenia is an autoimmune disease resulting in the destruction of platelets. It is classified as acute, thrombocytopenia occurring for < 6 mo and usually resolving spontaneously, and chronic, lasting > 6 mo and requiring therapy to improve the thrombocytopenia. The underlying defects leading to autoantibody production are unknown. Molecular mimicry appears to play a role in the development of self-reactive platelet antibodies after vaccination and certain viral infections. Platelet life span is reduced as a consequence of antibody-mediated clearance by tissue macrophages in essentially all patients. Diagnosis is based on the exclusion of the other causes of thrombocytopenia. Steroid is the first choice of the treatment, often followed by splenectomy in unresponsive cases. Intravenous immunoglobulin, anti-Rho(D) immune globulin, azathioprine, cyclosporine A, cyclophosphamide, danazol, dapsone, mycophenolate mofetil, rituximab, thrombopoietin receptor agonists and vinca alkaloids are other choices of treatment.
Core tip: In this manuscript we evaluate all aspects of immune thrombocytopenia (ITP). We outline the etiology, pathogenesis, diagnosis and treatment of ITP. We describe the first and second-line therapies in detail. Also, the mechanism of the actions of drugs is described.