Actualidades en el tratamiento de la púrpura trombocitopénica idiopática

Idiopathic thrombocytopenic purpura (ITP) is a clinical syndrome characterized mainly by widespread petechiae with a high rate of bleeding associated with antibody-mediated platelet destruction (peripheral blood platelets less than 100X109 /L).Has an incidence of 1.6 to 3.9 cases per 100,000 people per year. Its diagnosis is made by exclusion, ruling out other causes of thrombocytopenia. The primary goal of treatment is to prevent bleeding by controlling the number of platelets. It is recommended to treat patients with bleeding and figures below 30 000 platelets /mcL. The duration of treatment should be until there is an increase in the platelet number.The initial treatment should be steroids (prednisone, dexamethasone or methylprednisolone).You need to add another treatment in patients with severe thrombocytopenia, platelet counts with less than<10000/mcL, and when symptomatic despite treatment by two or three weeks with glucocorticoids. In patients refractory to steroids may be used other drugs. Cyclosporine has a platelet response up to 44 to 75% of patients. Of erythropoietin receptor agonists, romiplostim has shown promising results, as it increases the platelet, with fewer adverse effects and less need for splenectomy. Cyclophosphamide with complete response is only obtained in 10-20% of patients with chronic ITP and 40% of them achieved partial remission. Vinca alkaloids (vincristine and vinblastine), danazol, and splenectomy are other options.