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