IDIOPATHIC THROMBOCYTOPENIC PURPURA

IDIOPATHIC THROMBOCYTOPENIC PURPURA
Idiopathic thrombocytopenic purpura is thrombocytopenia without an underlying
causative disease or offending medication. Platelets are removed prematurely
by reticuloendolethial system. Peak incidence occurs in children (2–6 years
old) and adults (20–50 years old). Acute ITP is more common in children and
chronic ITP is more common in adults. Platelet counts of <20,000/mm3 may
cause life-threatening hemorrhage.
SYMPTOMS/EXAM
■ In children, often follows a viral infection
■ Petechiae, gingival bleeding, epistaxis, menorrhagia, GI bleeding, intracranial
hemorrhage
DIAGNOSIS
■ Isolated thrombocytopenia on CBC
■ Peripheral smear with a small number of well-granulated platelets
■ Bone marrow biopsy shows no primary bone marrow disorder.
TREATMENT
■ Treatment is reserved for severe bleeding with platelets <50,000/mm3 or
platelet count <10,000/mm3 without bleeding.
■ For children, treatment is usually conservative since the majority have a
favorable outcome. Children should avoid physical activity or NSAIDs.

■ Prednisone 1–1.5 mg/kg/day
■ IVIG or anti-D immunoglobulin
■ Platelet transfusion is not normally indicated and should be limited to
patients with life-threatening hemorrhage.
■ Those unresponsive to steroids and IVIG may need splenectomy or immune
modulation therapy.