Immune-mediated thrombocytopenia

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Sections available in full article Introduction, Presenting signs, Age predisposition, Sex predisposition, Breed predisposition, Cost considerations, Special risks (e.g. anesthetic), Pathogenesis, Etiology, Predisposing factors, Pathophysiology, Timecourse (incubation, duration), Diagnosis, Presenting problems, Client history, Clinical signs, Diagnostic investigation, Confirmation of diagnosis, Differential diagnosis, Treatment, Initial symptomatic treatment, Standard treatment, Monitoring, Subsequent management, Prevention, Control, Sequelae, Prognosis, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors Prof Bernard Feldman DVM PhD
Synonyms IMT, idiopathic thrombocytopenic purpura, ITP

Introduction

  • Most common cause of acquired defective hemostasis in dog.
  • Cause : characterized by increased destruction of antibody coated platelets.
  • Most often occurs as primary autoimmune disease but may occur secondary to infections, neoplasia or as an adverse reaction to medication.
  • Rare in cats.
  • Treatment : glucocorticoids, platelet transfusion, is most difficult due to logistics and potential immune reaction, immunosuppressive therapy.
  • Prognosis : good, rarely fatal.

Diagnosis

Clinical signs

  • Typical defective primary hemostasis.

Diagnosis

Differential diagnosis

  • Other causes of thrombocytopenia:
    • Disseminated intravascular coagulation Disseminated intravascular coagulation.
    • Primary bone marrow disorders.
  • Rickesttsial disease, eg Ehrlichia canis(not reported in UK).
  • Hypersplenism.
  • Pseudothrombocytopenia.

Sequelae

Prognosis

  • Good: dogs that survive an initial episode should achieve permanent remission without need for long-term therapy, within 6 months.
  • Fatal in <25% dogs affected.

Reasons for treatment failure

  • Due to gastrointestinal or CNS hemorrhage during first few weeks treatment.
  • Relapses during first 6 months therapy (relapses more difficult to treat than initial episode).
  • Owner influenced by side-effects medication/expense.

Sources

Publications

Refereed papers

  • Recent references from PubMed.
  • Botsch V et al(2009) Retrospective study of 871 dogs with thrombocytopenia. Vet Rec 164 , 647-651 PubMed.
  • Gould S M & McInnes E L (1999) Immune-mediated thrombocytopenia associated with Angiostrongylus vasorum infection in a dog. JSAP 40 , 227-232.

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