About Idiopathic Thrombocytopenic Purpura (ITP)

Overview

ITP, also known as primary immune thrombocytopenic purpura or autoimmune thrombocytopenic purpura, is an autoimmune disease in which circulating platelets are destroyed.ITP can be acute or chronic1,2:

Acute ITP is most often seen in children, of whom approximately 2/3 will recover spontaneously within 6 months. Acute ITP often, but not always, follows a viral infection, and boys and girls are affected equally. It has been demonstrated that an increased risk of ITP is also associated with the measles-mumps-rubella immunization.

Chronic ITP is the form typically seen in adults. It typically has an insidious onset with no preceding viral illness and lasts longer than 12 months.

Signs and Symptoms

Symptoms of ITP can vary widely and its diagnosis is often one of exclusion. Thrombocytopenia can be caused by systemic disease, infection, drugs and primary blood disorders.1,2 ITP is suspected when patient history, physical examination and laboratory blood tests do not suggest another reason for a low platelet count. 

Acute ITP presents as the sudden appearance of widespread petechiae and/or purpura in a previously healthy child, with large bruises following minor trauma. Nosebleeds and conjunctival hemorrhages are common. Most children do not require treatment except in the case of a life-threatening hemorrhage, such as a cerebral hemorrhage, which occurs very rarely. Only 10% of acute ITP cases progress to chronic ITP.2

Chronic ITP typically presents gradually, with minor bruising and scattered petechiae. Bleeding episodes are often not frequent and can be separated by months or years.2

Diagnosis

Common laboratory tests suggestive of ITP include2:

> Persistent platelet count of less than 40 X 109/L
> Peripheral blood smear may show large platelets or platelet fragments
> Bone marrow examination may show increased megakaryoctyes (suggestive of increased platelet production      consequent to the increased rate of platelet destruction in ITP)
> Anemia, if bleeding has occurred
> Direct tests on platelets show the presence of autoantibodies in 90% of patients with ITP 

Treatment  

The goal of treatment for ITP is to raise blood platelet counts to a normal range. Treatment may include IGIV, which has been shown to increase platelet counts in patients with ITP.1,2


References: 1. Provan D, Stasi R, Newland AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010;115:168-186. 2. Chapel H, Haeney SM and Snowden N. eds.  Non-Malignant Haematological Diseases In: Essentials in Clinical Immunology. 6th ed. John Wiley & Sons, Ltd., West Sussex, UK: John Wiley & Sons; 2014:305-308.
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Important Safety Information

GAMMAKED™ [Immune Globulin Injection (Human) 10% Caprylate/Chromatography Purified] is an immune globulin injection that is approved to treat primary humoral immunodeficiency (PI) in patients 2 years of age and older, idiopathic thrombocytopenic purpura (ITP) in adults and children, and chronic inflammatory demyelinating polyneuropathy (CIDP) in adults.

Boxed Warning: Thrombosis, Renal Dysfunction and Acute Renal Failure

  • Thrombosis may occur with immune globulin products, including GAMMAKED. Risk factors may include: advanced age, prolonged immobilization, hypercoagulable conditions, history of venous or arterial thrombosis, use of estrogens, indwelling vascular catheters, hyperviscosity, and cardiovascular risk factors. Thrombosis may occur in the absence of known risk factors.
  • For patients at risk of thrombosis, administer GAMMAKED at the minimum dose and infusion rate practicable. Ensure adequate hydration in patients before administration. Monitor for signs and symptoms of thrombosis and assess blood viscosity in patients at risk for hyperviscosity.
  • Renal dysfunction, acute renal failure, osmotic nephrosis, and death may occur with immune globulin intravenous (IGIV) products in predisposed patients. Patients predisposed to renal dysfunction include those with any degree of pre-existing renal insufficiency, diabetes mellitus, age greater than 65, volume depletion, sepsis, paraproteinemia, or patients receiving known nephrotoxic drugs.
  • Renal dysfunction and acute renal failure occur more commonly in patients receiving IGIV products containing sucrose. GAMMAKED does not contain sucrose.
  • For patients at risk of renal dysfunction or failure, administer GAMMAKED at the minimum concentration available and the minimum infusion rate practicable.

GAMMAKED is contraindicated in patients who have had an anaphylactic or severe systemic reaction to human immunoglobulin. It is also contraindicated in IgA deficient patients with antibodies against IgA and history of hypersensitivity. Have epinephrine available immediately to treat any acute severe hypersensitivity reactions.

Hyperproteinemia, increased serum viscosity, and hyponatremia may occur in patients receiving IGIV therapy, including GAMMAKED.

Aseptic Meningitis Syndrome (AMS) may occur infrequently, especially with high doses or rapid infusion.

Hemolysis, either intravascular or due to enhanced red blood cell (RBC) sequestration, can develop subsequent to GAMMAKED treatment. Risk factors include high doses and non-O blood group. Closely monitor patients for hemolysis and hemolytic anemia, especially in patients with pre-existing anemia and/or cardiovascular or pulmonary compromise.

Noncardiogenic pulmonary edema may occur in patients following treatment with IGIV products, including GAMMAKED. Monitor patients for pulmonary adverse reactions (transfusion-related acute lung injury [TRALI]).

The high dose regimen (1g/kg x 1-2 days) is not recommended for individuals with expanded fluid volumes or where fluid volume may be a concern.

GAMMAKED is made from human plasma. Because this product is made from human plasma, it may carry a risk of transmitting infectious agents, e.g., viruses, the variant Creutzfeldt-Jakob disease (vCJD) agent and, theoretically, the Creutzfeldt-Jakob disease (CJD) agent.

GAMMAKED is not approved for subcutaneous use in patients with ITP. Due to the potential risk of hematoma formation, GAMMAKED should not be administered subcutaneously in patients with ITP.

After infusion of IgG, the transitory rise of the various passively transferred antibodies in the patient's blood may yield positive serological testing results, with the potential for misleading interpretation.

In clinical studies, the most common adverse reactions with GAMMAKED (≥5% of subjects) were: (in PI intravenous) cough increased, rhinitis, pharyngitis, headache, asthma, nausea, fever, diarrhea, and sinusitis; (in PI subcutaneous) local infusion site reactions, fatigue, headache, upper respiratory tract infection, arthralgia, diarrhea, nausea, sinusitis, bronchitis, depression, allergic dermatitis, migraine, myalgia, viral infection, and pyrexia; (in ITP) headache, ecchymosis, vomiting, fever, nausea, rash, abdominal pain, back pain, and dyspepsia; (in CIDP) headache, pyrexia, hypertension, chills, rash, nausea, arthralgia, and asthenia.

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