ITP is a disorder of increased platelet destruction caused by the development of platelet autoantibodies.
- 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.
- 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
- Myelodysplastic diseases
- Lymphoproliferative diseases
- 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.
- 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