IDIOPATHIC THROMBOCYTOPENIC PURPURA

ITP is a disorder of increased platelet destruction caused by the development of platelet autoantibodies.

ETIOLOGY/ PATHOGENESIS

  • Also known as isolated thrombocytopenia, ITP is a diagnosis of exclusion.
  • It occurs in children as acute ITP, typically follows an acute viral or upper respiratory infection, and resolves spontaneously within several months.
  • In adults it occurs as chronic ITP and affects more women than men in a 3:1 ratio.
  • Spontaneous remission in adults is rare.
  • Intracranial hemorrhage is the most significant complication.

CLINICAL SYMPTOMS

  • Children often present with sudden onset of bruising and petechiae
  • Adults may have history of easy bruising
  • Women may have history of menometrorrhagia

PHYSICAL EXAM FINDINGS

  • In adults physical exam is usually normal.
  • Patients may present with epistaxis, gingival bleeding or ecchymosis

DIFFERENTIAL DIAGNOSIS

  • TTP
  • SLE
  • Myelodysplastic diseases
  • Lymphoproliferative diseases

DIAGNOSTIC EVALUATIONS

  • Complete blood count: thrombocytopenia; large platelets on peripheral smear
  • PT/aPTT: normal
  • Bone marrow examination in chronic ITP
  • ANA in patients with chronic TTP to rule out SLE
  • Platelet count is often less than 30×109/L at the time of diagnosis.
  • In chronic ITP a bone marrow examination is performed to rule out other causes of thrombocytopenia. In ITP the bone marrow has increased numbers of megakaryocytes.

MEDICAL MANAGEMENT

  • Treatment is not usually initiated unless platelet count is <20,000/µL except in cases of hemorrhage.
  • Prednisone will increase platelet count and possibly decrease autoantibody production
  • Splenectomy in patients not responsive to prednisone
  • Immunosuppressive drugs in patients not responding after splenectomy or in relapse after initial therapy
  • IV gamma globulin (IVIgG) is known to temporarily increase platelet counts

PATIENT EDUCATION/ MAINTENANCE – PREVENTION

  • Avoid contact sports/activities associated with high incidence of trauma

Avoid ASA products

One thought on “IDIOPATHIC THROMBOCYTOPENIC PURPURA

  1. Pingback: IDIOPATHIC THROMBOCYTOPENIC PURPURA | Dr. Zachary Lahlou

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