When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Immune thrombocytopenia

最后审阅: 18 Aug 2025
最后更新: 09 Jul 2024

小结

定义

病史和体格检查

关键诊断因素

  • bleeding
  • absence of systemic symptoms
  • absence of medications that cause thrombocytopenia
  • absent splenomegaly or hepatomegaly
  • absent lymphadenopathy
完整详情

危险因素

  • age <5 or >65 years
  • women of childbearing age
完整详情

诊断性检查

首要检查

  • CBC and peripheral blood smear
完整详情

需考虑的检查

  • HIV serology
  • Helicobacter pylori breath test or stool antigen test
  • hepatitis C serology
  • thyroid function tests and antithyroid antibody tests
  • quantitative immune globulins
  • bone marrow biopsy/aspiration
  • pregnancy test
完整详情

治疗流程

初步治疗

all patients (child or adult): with life- or organ-threatening bleeding

急症处理

newly diagnosed child

newly diagnosed adult (pregnant or nonpregnant):

持续性治疗

child: persistent or chronic disease

adult nonpregnant: persistent or chronic disease

pregnant: persistent or chronic disease

撰稿人

作者

Hanny Al-Samkari, MD

Division of Hematology/Oncology

Peggy S. Blitz Endowed Chair in Hematology/Oncology

Massachusetts General Hospital

Associate Professor of Medicine

Harvard Medical School

Boston

MA

利益声明

HA has received research funding to their institution from Agios, Amgen, Novartis, Sobi and Vaderis; and received fees for consulting from Agios, Amgen, Forma, argenx, Novartis, Sobi, Moderna and Pharmacosmos.

鸣谢

Dr Al-Samkari would like to gratefully acknowledge Dr Marie Scully, Professor Francesco Rodeghiero and Dr Marco Ruggeri, previous contributors to this topic.

利益声明

MS received honoraria from Novartis and is the author of a paper cited in this topic. FR received fees for speaking and has been reimbursed by GSK and Amgen, the manufacturer of eltrombopag and romiplostim, for attending several conferences, and also received fees for consulting from GSK and Shionogi. FR and MR are authors of a number of papers cited in this topic.

同行评议者

Keith McCrae, MD

Professor

Director of Benign Hematology

Cleveland Clinic

Cleveland

OH

利益声明

KM declares that he has no competing interests.

Sandeep Kumar Rajan, MD

Assistant Professor

Division of Oncology-Hematology

Department of Internal Medicine

University of Nebraska Medical Center

Omaha

NE

利益声明

SKR declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Rodeghiero F, Stasi R, Gernsheimer T, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009 Mar 12;113(11):2386-93.全文  摘要

Provan D, Arnold DM, Bussel JB, et al. Updated international consensus report on the investigation and management of primary immune thrombocytopenia. Blood Adv. 2019 Nov 26;3(22):3780-817.全文  摘要

Neunert C, Terrell DR, Arnold DM, et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv. 2019 Dec 10;3(23):3829-66.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • 鉴别诊断

    • Pseudothrombocytopenia
    • Congenital thrombocytopenia
    • Acquired thrombocytopenia (e.g., related to liver disease or alcohol ingestion)
    更多 鉴别诊断
  • 指南

    • Updated international consensus report on the investigation and management of primary immune thrombocytopenia
    • American Society of Hematology 2019 guidelines for immune thrombocytopenia
    更多 指南
  • padlock-locked登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容

内容使用需遵循免责声明