ITP Types According to HAL
Find ones ITP row type by matching steroid and IVIG responses to the row in the table below.
A single antibody on diagnosis is common. Combinations are possible though. A row 1 and row 2 combination is listed here since it appears to be the most common. A '1 & 2' combination is intended to mean a row 1 dominant response. A '2 & 1' combination would be a row 2 dominant response. Other row combinations are not included here for brevity. An example would be row 3 & 4.
|Antibody||Target||Location||Steroid Resp||IVIG Resp||Typical Promacta Resp||Other Effective Treatments||Possible Remission||Possible Trigger|
|Platelets||Spleen||Good||Good, Strong||25mg||Promacta, Nplate, Dapsone, WinRho, Azathioprine (Imuran)||Steroids, IVIG, Promacta, Nplate, Azathioprine (Imuran), Rituxan, Cyclophosphamide (Cytoxan)||
|1&2||GPIIb-IIIa & GPIb-IX||Mostly Spleen||Partial||Weak||50mg||Promacta, Nplate, Dapsone, WinRho, Azathioprine (Imuran)||Row 1 and row 2 combination?||HHV-4 or Influenza|
|2&1||Mostly Liver||Partial||Weak||50mg → 0||Promacta1, Nplate1, Tamiflu?||Promacta1, Nplate1
A 'partial' remission is common
|Liver||Poor3||Poor3||50mg → 0||Promacta1, Nplate1, Tamiflu?||Promacta1, Nplate1, Rituxan2
A 'full' remission is common
Mimicry with TPO
|Thrombopoietin (TPO)||Spleen||Poor||Strong||12mg||Promacta, Nplate, Danazol, MMF (CellCept)||Danazol, MMF (CellCept)||HHV-3
(Chickenpox / Shingles)
Mimicry with Meg
|Megakaryocyte (Meg)||Bone||Poor||Weak||75-100mg||Promacta, Nplate, Cyclosporine, Fostamatinib?||?|
1 - Treatment 'time to response' and 'time to remission' can be significantly improved when steroids are combined with Promacta or Nplate.
2 - Rituxan remission is rare but possible. Concurrent moderate dose of steroids may improve possibility.
3 - Steroid and IVIG treatment combined can provide a good response where either treatment alone will not.
|Counts rise to normal levels
Counts rise to 50-60 range and then stop
Counts do not rise materially above baseline
|IVIG (1g/kg/day for 2 days):|
|Counts rise to normal levels, then return to baseline after ~4 or more weeks
Counts rise to normal levels, then return to baseline after ~2 weeks
Counts rise to 50-100, then return to baseline after ~1 week
Counts do not rise or rise for 1-3 days, then return to baseline
Odds and Ends:
|•||Remission via Rituxan is prominent in row type 1 and occasionally occurs in row type 2.|
|•||Extended treatment times may be necessary to overcome T cell involvement in row type 1.|
|•||Full remission via Promacta/Nplate are a dominant feature of row type 2. Typically, dose requirements decline over time.|
|•||Some do not respond to Promacta at all, but will respond well to Nplate.|
|•||Some need a higher dose of Promacta than is available. In such cases switching to a high dose of Nplate is required.|
|•||Because immune response can ramp up and down, avoid skipping Promacta doses with row type 1.|
|•||Because of rebound thrombocytopenia, taper the dose over time when discontinuing Promacta/Nplate for row type 1.|
|•||A count less than ~12 with bleeding at diagnoses is more common in row types 1 and 2 then in row types 3 or 4.|
|•||Avoiding foods, or environmental factors, one is allergic or sensitive to might increase counts.|
Promacta and Nplate approximate dose equivalents.
|Promacta (mg)||Nplate (ug/kg)|
Four known types of ITP:
Autoantibodies to Thrombopoietin and the Thrombopoietin Receptor in Patients with Immune Thrombocytopenia
General ITP info and treatments:
ITP, A Practical Guide for Nurses and Other Allied Healthcare Professionals
Dr. Drew Provan video and slide show on ITP (doesn't work in Chrome browser)
ITP in 2010: new agents and changing treatment paradigm
General ITP info and treating single ITP type affliction:
International consensus report on the investigation and management of primary immune thrombocytopenia
Using Azathioprine, MMF, and Cyclosporine combination treatment for multiple ITP type affliction:
Combination immunosuppressant therapy for patients with chronic refractory immune thrombocytopenic purpura
Like steroids, Cyclosporine is an anti-inflammatory. But it can work on some T cells where steroids will not.
How immune suppressant drugs act on T cells:
An Update on Immunosuppressive Medications in Transplantation
Herpes virus subfamilies: Alpha, Beta, and Gamma as listed on Wikipedia:
Controlling Epstein-Barr (HHV-4) virus with NAC supplement:
N-acetylcysteine (NAC) ameliorates Epstein-Barr virus latent membrane protein 1 induced chronic inflammation
Full or partial remission via Promacta or Nplate:
No Response to IVIG, ACK!
Flu vaccine effectiveness versus Vitamin D effectiveness:
Vitamin D And Flu Prevention | Strengthening Innate Immunity
Chickenpox (HHV-3) induced ITP:
Chickenpox-associated immune thrombocytopenic purpura
No studies support or refute high Lysine foods reduce Shingles HHV-3 outbreaks.
But Lysine has been studied and proven effective for other alpha subfamily herpes virus such as HHV-1:
L-lysine and Shingles
Lysine to Arginine ratio of a variety of foods:
Lysine and Arginine Food Guide
Increasing Glutathione antioxidant levels:
Glutathione: The ‘Master Antioxidant’ That Your Body Needs
Update: 15 Jan 2019