Management of Immune Thrombocytopenia in a Tertiary Hospital: Insights from a Case Series

AYM Nazim Uddin¹, Salma Afrose², Mohiuddin Ahmed Khan³, Tasneem Ara⁴, Mafruha Akhter⁵, Alamgir Ahmed⁶, Tanzil Sajjad⁷

1. Assistant Professor (CC), Haematology, North East Medical College Hospital, Sylhet
2. Professor, Department of Haematology & BMT, Dhaka Medical College Hospital, Dhaka
3. Professor, Department of Haematology & BMT, Dhaka Medical College Hospital, Dhaka
4. Professor, Department of Haematology, Ahsania Mission Cancer & General Hospital, Dhaka
5. Associate Professor, Department of Haematology& BMT, Dhaka Medical College Hospital, Dhaka
6. Associate Professor, Department of Clinical Pathology, Bangladesh Shishu Hospital & Institute, Dhaka
7. Associate Professor, Department of Community Medicine, Sylhet Women’s Medical College Hospital, Sylhet

Abstract
Immune thrombocytopenia (ITP) is a disorder where the immune system destroys platelets, leading to low platelet counts and an increased risk of bleeding. Symptoms often include easy bruising, gum bleeding, and excessive bleeding. Treatment for ITP is tailored to each patient, depending on the severity of the condition, age, existing health conditions, and prior responses to therapy. This article examines five distinct case studies, each showcasing different management strategies, emphasizing the importance of personalized care. These cases cover various presentations, such as acute ITP treated with steroids, refractory ITP in older patients treated with thrombopoietin receptor agonists and immunosuppressants, and pediatric ITP managed through careful observation. Other cases involve managing ITP during pregnancy, balancing risks for both mother and fetus, and secondary ITP related to hepatitis C, which improves with treatment aimed at the underlying infection. The article highlights the need for individualized treatment plans and underscores the current guidelines, which suggest conservative management to avoid overtreatment while focusing on long-term disease control. Emerging therapies, such as thrombopoietin receptor agonists, immunosuppressants, Rituximab, and SYK inhibitors like Fostamatinib, are crucial for managing chronic, persistent, and refractory cases of ITP.

Key Words: Immune thrombocytopenia (ITP), Corticosteroids, Thrombopoietin receptor agonists, Immunosuppressants, Acute ITP, Chromic ITP, Persistent ITP

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