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
危险因素
- age <5 or >65 years
- women of childbearing age
诊断性检查
首要检查
- CBC and peripheral blood smear
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
治疗流程
all patients (child or adult): with life- or organ-threatening bleeding
newly diagnosed child
newly diagnosed adult (pregnant or nonpregnant):
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
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
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