Primary Immune Thrombocytopenia with Multiple Intracranial Hemorrhage：Report of One Case and Literature Review

doi:10.12114/j.issn.1007-9572.2019.00.053

Abstract

Abstract: Cerebral hemorrhage and visceral hemorrhage are the most serious complications of primary immune thrombocytopenia （ITP），which are commonly seen in hematonosis patients，with extremely high mortality.We reported the clinical diagnosis and treatment of one case of ITP with multiple intracranial hemorrhages.The patient had been diagnosed with thrombocytopenic purpura for more than 20 years.During this period，she had suffered from 3 times of intracerebral hemorrhage involving multiple compartments and one time of gastrointestinal hemorrhage.As the amount of bleeding was not large，she has good survival，which is rarely seen clinically and may be related to the actions of other hemostatic mechanisms.Moreover，on the basis of the reviewing of related studies，we found some effective prevention and treatment measures for ITP，in order to offer some assistance for clinicians.

Key words: Thrombocytopenia, Intracranial hemorrhage, Mechanism, Treatment outcome

摘要： 原发免疫性血小板减少症（ITP）最严重的并发症是脑出血和内脏出血，是血液病常见的并发症，病死率极高。本文报道了1例ITP并发多次颅内出血患者的临床诊疗经过，该患者确诊血小板减少性紫癜20余年，期间3次颅内出血，而且是颅内多部位出血，1次消化道出血，均出血量不大，未引起患者死亡，临床极其罕见，显示可能有其他的止血机制发挥作用，因此笔者结合文献复习，以期寻找到ITP患者脑出血的有效预防及治疗措施，为临床提供帮助。

关键词: 血小板减少, 颅内出血, 机制, 治疗结果

HUANG Weiqi,ZHOU Yongming. Primary Immune Thrombocytopenia with Multiple Intracranial Hemorrhage：Report of One Case and Literature Review　[J]. Chinese General Practice, 2019, 22(27): 3373-3376. DOI: 10.12114/j.issn.1007-9572.2019.00.053.
黄炜祺,周咏明. 原发免疫性血小板减少症并发多次颅内出血一例报道并文献复习[J]. 中国全科医学, 2019, 22(27): 3373-3376. DOI: 10.12114/j.issn.1007-9572.2019.00.053.

References

［1］中华医学会血液学分会血栓与止血学组.成人原发免疫性血小板减少症诊断与治疗中国专家共识（2012年版）［J］．中华血液学杂志，2012，33（11）：975-977．DOI：10.3760/cma.j.issn.0253-2727.2012.11.021.
［2］NEUNERT C，LIM W，CROWTHER M，et al．The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia［J］．Blood，2011，117（16）：4190-4207．DOI：10.1182/blood-2010-08-302984.
［3］NEUNERT C，NOROOZI N，NORMAN G，et al．Severe bleeding events in adults and children with primary immune thrombocytopenia：a systematic review［J］．J Thromb Haemost，2015，13（3）：457-464．DOI：10.1111/jth.12813.
［4］PORTIELJE J E，WESTENDORP R G，KLUIN-NELEMANS H C，et al．Morbidity and mortality in adults with idiopathic thrombocytopenic purpura［J］．Blood，2001，97（9）：2549-2554.
［5］NIELSEN O H，TUCKUVIENE R，NIELSEN K R，et al．Flow cytometric measurement of platelet-associated immunoglobulin in children with newly diagnosed immune thrombocytopenia［J］．Eur J Haematol，2016，96（4）：397-403．DOI：10.1111/ejh.12605.
［6］CINES D B，CUKER A，SEMPLE J W.Pathogenesis of immune thrombocytopenia［J］．Presse Med，2014，43（4 Pt 2）：49-59．DOI：10.1016/j.lpm.2014.01.010.
［7］QIU J，LIU X，LI X，et al．CD8+ T cells induce platelet clearance in the liver via platelet desialylation in immune thrombocytopenia［J］．Sci Rep，2016，6：27445．DOI：10.1038/srep27445.
［8］EMMERICH F，BAL G，BARAKAT A，et al．High-level serum B-cell activating factor and promoter polymorphisms in patients with idiopathic thrombocytopenic purpura［J］．Br J Haematol，2007，136（2）：309-314．DOI：10.1111/j.1365-2141.2006.06431.x.
［9］MIN Y N，WANG C Y，LI X X，et al．Participation of B-cell-activating factor receptors in the pathogenesis of immune thrombocytopenia［J］．J Thromb Haemost，2016，14（3）：559-571．DOI：10.1111/jth.13246.
［10］THAI L H，LE GALLOU S，ROBBINS A，et al．BAFF and CD4+ T cells are major survival factors for long-lived splenic plasma cells in a B-cell-depletion context［J］．Blood，2018，131（14）：1545-1555．DOI：10.1182/blood-2017-06-789578.
［11］RUSSO G，MIRAGLIA V，BRANCIFORTE F，et al．Effect of eradication of Helicobacter pylori in children with chronic immune thrombocytopenia：a prospective，controlled，multicenter study［J］．Pediatr Blood Cancer，2011，56（2）：273-278．DOI：10.1002/pbc.22770.
［12］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［J］．Blood，2009，113（11）：2386-2393．DOI：10.1182/blood-2008-07-162503.
［13］PROVAN D，STASI R，NEWLAND A C，et al．International consensus report on the investigation and management of primaryimmune thrombocytopenia［J］．Blood，2010，115（2）：168-186．DOI：10.1182/blood-2009-06-225565.
［14］秦平，侯明.2012版成人原发免疫性血小板减少症诊治的中国专家共识解读［J］．临床血液学杂志，2013，26（3）：151-155．DOI：10.13201/j.issn.1004-2806.2013.02.006.
［15］杨仁池.难治性原发免疫性血小板减少症定义及临床处理［J］．中国实用内科杂志，2017，37（2）：96-98．DOI：10.19538/j.nk2017020103.
［16］YANG R，LI J，JIN J，et al．Multicentre，randomised phase Ⅲ study of the efficacy and safety of eltrombopag in Chinese patients with chronic immune thrombocytopenia［J］．Br J Haematol，2017，176（1）：101-110．DOI：10.1111/bjh.14380.
［17］KHELIF A，SALEH M N，SALAMA A，et al．Changes in health-related quality of life with long-term eltrombopag treatment in adults with persistent/chronic immune thrombocytopenia：findings from the EXTEND study［J］．Am J Hematol，2019，94（2）：200-208．DOI：10.1002/ajh.25348.
［18］BUSSEL J B，KUTER D J，ALEDORT L M，et al．A randomized trial of avatrombopag，an investigational thrombopoietin-receptor agonist，in persistent and chronic immune thrombocytopenia［J］．Blood，2014，123（25）：3887-3894．DOI：10.1182/blood-2013-07-514398.
［19］NEUNERT C E.Current management of immune thrombocytopenia［J］．Hematology Am Soc Hematol Educ Program，2013，2013：276-282．DOI：10.1182/asheducation-2017.1.400.
［20］YOON J S，LEE Y J，BAEK D W，et al．New synergistic efficacy of combination of romiplostim and steroid in refractory immune thrombocytopenia patients［J］．Korean J Intern Med，2018，33（2）：435-437．DOI：10.3904/kjim.2015.252.

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