Internal Medicine

0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:40

810 Idiopathic (Immune) Thrombocytopenic Purpura (ITP) Immune Hemolytic

➣Danazol androgen: orally for 2–3 months; side effects include

acne, hirsutism, weight gain, liver toxicity

➣Azathioprine: used in other autoimmune disorders; side effects

include neutropenia

➣Cyclophosphamide: orally for 2–10 weeks or IVq3weeks; side

effects include bone marrow suppression, alopecia, liver toxicity,

hemorrhagic cystitis, secondary leukemia

Rituximab: weekly for 3–6 weeks in steroid-dependent cases

instead of splenectomy in more chronic ITP or in Evan’s syn-

drome. Monoclonal anti-CD20 antibody. Side effects include

anaphylaxis, life-threatening mucocutaneous syndrome. Give

only by slow iv infusion.

Thrombopoietin mimetics may become a therapeutic option

in the near future as clinical trials support efficacy in ITP.

specific therapy

n/a

follow-up

n/a

complications and prognosis

■Acute ITP: about 90% of children recover within 6 months with or

without therapy; <1% intracranial hemorrhage

■Chronic ITP: thrombocytopenia of >6 months; accounts for 10% of

childhood ITP; may later develop other chronic autoimmune disor-

der (e.g., SLE)

Immune Hemolytic Anemia............................

CHRISTINE CSERTI, MD; FRANK J. STROBL, MD; and LESLIE SILBERSTEIN, MD

history & physical

Etiology

■encompasses several autoantibody- and alloantibody-mediated dis-

orders that result in accelerated red blood cell destruction

■autoantibodies: warm autoimmune hemolytic anemia (WAHA), cold

autoimmune hemolytic anemia (CAHA), paroxysmal cold hemo-

globinuria (PCH), mixed-type (warm and cold reactive antibody

induced) autoimmune hemolytic anemia (MTHA), drug-induced

hemolytic anemia (DIHA)