Platelet
Immune Thrombocytopenic Purpura
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Immune Thrombocytopenic Purpura
, Idiopathic Thrombocytopenic Purpura, ITP
See Also
Thrombocytopenia
Drug induced Thrombocytopenia
Epidemiology
Incidence
: 10 cases per 100,000
Children comprise 50% of cases
Most common
Thrombocytopenia
cause in children
Peak onset between ages 2 to 4 years
Pathophysiology
IgG
Antibody
develops against platelet membrane
Antigen
Acute Idiopathic Thrombocytopenic Purpura
Acute onset follows
Viral Exanthem
or viral Infection
Occurs in otherwise healthy patients
Chronic Idiopathic Thrombocytopenic Purpura
Insidious onset in patient with immune disorder
More common onset in teenage girls
Causes
Secondary Immune Thrombocytopenic Purpura
Lymphoproliferative Disorders or
Myelodysplastic Syndrome
Evaluate in all patients over age 60 years with Immune Thrombocytopenic Purpura
Systemic Lupus Erythematosus
Antiphospholipid Syndrome
Graves Disease
Sarcoidosis
HIV Infection
Epstein-Barr Virus Infection
(EBV or mononucleosus)
Cytomegalovirus
(CMV)
Varicella-Zoster Virus
Hepatitis C
Virus
Signs and Symptoms
Purpura
Bleeding complications
Associated with severe
Thrombocytopenia
(
Platelet Count
<30,000 per uL)
Mild
Splenomegaly
in 5 to 10% of cases
Absent signs
No fever, lethargy, pallor or weight loss
No bone or
Joint Pain
No
Lymphadenopathy
No
Hepatomegaly
Labs
Platelet Count
drops rapidly
Management
First-Line Management
Corticosteroid
s
Indicated for severe
Thrombocytopenia
Typically indicated with
Platelet Count
<50,000 per uL (especially <30,000 per uL)
Platelets increase within a week of starting
Corticosteroid
s
Dosing
Methylprednisolone
30 ml/kg/day over 20-30 min up to 1 g/day IV OR
Prednisone
1-1.5 mg/kg orally daily
Intravenous Immune globulin (IV IG)
Dose: 1 g/kg/day for 2-3 days
Rituximab
(Rituxan)
Management
Emergent management
Indications for urgent or emergent management (uncommon)
Serious
Hemorrhage
Urgent or emergent surgery required
Treatment
Platelet Transfusion
at dosing 2-3 fold greater than usual dose
Management
Refractory cases
Anti-D Immune globulin
May be used in Rh Positive patients
May be considered as alternative to
Corticosteroid
s
Thrombopoietin receptor agonist
Splenectomy
Indicated if corticosterioids and
Immunoglobulin A
re ineffective at maintaining adequate
Platelet Count
s
Safe and effective (however subjects patient to lifelong
Asplenia
risk)
May be preferred in younger patients
Gadenstatter (2002) Am J Surg 184:606-10 [PubMed]
Course
Children: Acute Idiopathic Thrombocytopenic Purpura
Less severe in children
Recovery within 6 to 12 months for 80-90% of children
Most cases resolve within weeks
Adults
More chronic, insidious course than for adults
References
Merrill and Gillen (2016) Crit Dec Emerg Med 30(3): 3-8
Blanchette (2000) Semin Hematol 37(3):299-314 [PubMed]
Bolton-Maggs (2000) Arch Dis Child 83(3):220-2 [PubMed]
Gauer (2012) Am Fam Physician 85(6): 612-22 [PubMed]
George (1996) Blood 88:3-40 [PubMed]
Souid (1995) Clin Pediatr 34:487-94 [PubMed]
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