Difference between revisions of "Immune thrombocytopenic purpura"

(Types)
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*Because circulating platelets are functional, life-threatening bleeding only once platelet count <10K
 
*Because circulating platelets are functional, life-threatening bleeding only once platelet count <10K
  
==Types==
+
===Types===
 
*Acute
 
*Acute
 
**More common among younger children
 
**More common among younger children

Revision as of 05:07, 6 June 2015

Background

  • Acquired autoimmune disease resulting in destruction of platelets
  • Because circulating platelets are functional, life-threatening bleeding only once platelet count <10K

Types

  • Acute
    • More common among younger children
    • Affects men/women equally
    • Resolves in 1-2 months
  • Chronic
    • Lasts > 3 months
    • More common in adults and women
    • Rarely remits spontaneously or with treatment
    • More likely to have an underlying disease or autoimmune disorder (e.g. SLE)

Clinical Features

  • Petechiae
  • Epistaxis, gingival bleeding, menorrhagia

Diagnosis

  • Diagnosis of exclusion
  • Must differentiate acute ITP from chronic ITP, which suggests an underlying disorder
  • CBC shows normal cell lines except for the platelets (may have mild anemia)

Treatment Options

  1. First choice in adults: Corticosteroids
    1. Prednisone 60-100 mg/d with taper after count reaches normal
    2. Methylprednisolone 30mg/kg/d IV x 3 days (for life-threatening bleeding)
  2. First choice in children: Intravenous Immunoglobulin G (IVIG) 1gm/kg/d x 2 days
  3. Anti-D (RhoGAM): patient must be Rh+ for it to work
  4. Transfusion (platelets)
    1. Indicated for life-threatening bleeding
    2. Transfuse only following first dose of methylprednisolone or IVIG
      1. Holding transfusion until after first dose results in greater rise in platelet count
  5. Estrogen for uterine bleeding: 25mg IV x1

Treatment Indications

Adults

  1. Plt >30K and asymptomatic: usually do not require treatment
  2. Plt count <30K: prednisone
  3. Plt <50K AND bleeding: prednisone
  4. Life-threatening bleeding: IVIG, methylprednisolone, platelet transfusion

Children

  1. Platelet count >30K: usually do not require treatment
  2. Platelet count <20K + significant bleeding: IVIG
  3. Platelet count <10K: IVIG
  4. Life-threatening bleeding: IVIG, methylprednisolone, platelet transfusion

Disposition

  1. Admit: platelet count <20K or significant mucous membrane bleeding
  2. Discharge: platelet count >20K AND asymptomatic OR only minor petechiae

Complications

  1. Rare: more common in elderly
    1. Intracerebral bleeding
    2. Severe GI bleeding

See Also

ITP in Pregnancy

Source

  • Tintinalli
  • UpToDate