Immune thrombocytopenic
purpura (ITP)
Clinical
presentation
Diagnosis
Management
Complications
Definition
Epidemiology
Pathophysiology
Aquired haematological disorder
of reduced platelets and
bleeding tendancy
Commonest cause of thrombocytopenia
in childhood
Present between 2-10y
Defect
Development of anti-platelet auto-Abs,
usually following acute viral infection (1-2wk)
May be mild, moderate or severe loss of Plt
Mechanism
Destruction of circulating Plts by IgG auto-Abs
BM may try to compensate by increasing megakaryocyte production
Purpura
Bruising
Petechiae
Epistaxis
ICH
Rare, often only if severe
and prolonged drop in Plt
Examination
Investigations
History
PC/HPC
Acute onset bruising, petechiae, epistaxis
Recent viral infection 1-2wk
PMH
Growth and development
Vaccinations
Known medical conditions
DH
Meds, allergies
FH
ITP, haemophilia, vWF
SH
Living arrrangements,
nursery/school/occupation
Derm exam
Petechiae, purpura,
bruising, epistaxis
Bloods
FBC (low Plt), Fe studies (normal), clotting (nil),
G+S, crossmatch (incase of major haemorrhage)
Immune screen (anti-Plt Abs +ve)
Genetic screen (haemophilia, vWF -ve)
Blood film (nil)
Bedside
Obs
Conservative
Information, advice, support
Avoid contact sports
Monitoring (SLE)
Medical
Steroids
Indication: evidence of bleeds
E.g. PO prednisolone
IV Ig
Indication: severe bleed
Anti-D
Indication: severe bleeds
Splenectomy
Indication: relapse, unresponsive disease
MOA: can be curative
Plt transfusion
Indication: life threatening haemorrhage
MOA: raises count temporarily,
plts inevitably destroyed by Ig
Prognosis
Acute, benign and
self limiting <8w in most
Chronic ITP in 20%
Rituximab
Indication: chronic, symptomatic ITP
MOA: inhibition of B-cells producing Ab