（血液内科ppt课件）083特发性血小板减少性紫癜.pptVIP

Idiopathic ThrombocytopeniaPurpura （Immune Thrombocytopenia） 特发性血小板减少性紫癜 王 利 重庆医科大学附属第一医院 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 gums 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 μl. • A very low count (10,000 per μl) may result in the spontaneous formation of hematomas (blood masses) in the mouth or on other mucous membranes. Clinical presentation Acute ITP Chronic ITP Age Gender Induction Onset 2-6 yrs ND URI 2-3w before onset Prompt 速发/with chilly, fever Mainly 20-40 yrs Mainly Female, M：F=1：4 Mainly infection induced Slow，hid