CV: Platelet disorders

Question 1

Acute idiopathic thrombocytopenic purpura is usually self-limiting in children. In adults, how can it be treated?

Answer 1

Via a corticosteroid, e.g. prednisolone, gradually reducing the dose over several weeks.

Question 2

What surgery can be considered in adults with idiopathic thrombocytopenic purpura who cannot achieve a satisfactory platelet count despite treatment with a corticosteroid?

Answer 2

Splenectomy.

Question 3

Anti-D (Rh0) immunoglobin is effective in raising the platelet count in about what % of unsplenetomised rhesus-positive individuals?

Answer 3

80%.

Question 4

For patients with chronic severe thrombocytopenia refractory to other therapy, what can be given to reduce the severity of haemorrhage?

Answer 4

Tranexamic acid

Question 5

Eltrombopag and romiplostim are ______________ receptor agonists licensed for the treatment of chronic idiopathic thrombocytopenic purpura.

Answer 5

Eltrombopag and romiplostim are thrombopoietin receptor agonists licensed for the treatment of chronic idiopathic thrombocytopenic purpura in splenectomised patients refractory to other treatments, such as corticosteroids or immunoglobulins, or as a second-line treatment in non-splenectomised patients when surgery is contra-indicated (see also NICE guidance).

Question 6

Anagrelide inhibits what?

Answer 6

Platelet formation.
It is licensed for essential thrombocythaemia in patients at risk of thrombo-haemorrhagic events who have not responded adequately to other drugs or who cannot tolerate other drugs. An at risk patient is defined by one or more of the following features: over 60 years of age, or a platelet count greater than 1000 x 109 /L or history of thrombo-haemorrhagic events. Anagrelide should be initiated under specialist supervision.

Question 7

Anagrelide, platelet formation inhibitor, is licensed for what?

Answer 7

It is licensed for essential thrombocythaemia in patients at risk of thrombo-haemorrhagic events who have not responded adequately to other drugs or who cannot tolerate other drugs. An at risk patient is defined by one or more of the following features: over 60 years of age, or a platelet count greater than 1000 x 109 /L or history of thrombo-haemorrhagic events. Anagrelide should be initiated under specialist supervision.