Difference between revisions of "Immune thrombocytopenic purpura"

(Types)
Line 24: Line 24:
  
 
==Treatment Options==
 
==Treatment Options==
#'''First choice in adults:''' Corticosteroids  
+
*'''First choice in adults:''' Corticosteroids  
##Prednisone 60-100 mg/d with taper after count reaches normal  
+
**Prednisone 60-100 mg/d with taper after count reaches normal  
##Methylprednisolone 30mg/kg/d IV x 3 days (for life-threatening bleeding)
+
**Methylprednisolone 30mg/kg/d IV x 3 days (for life-threatening bleeding)
#'''First choice in children:''' Intravenous Immunoglobulin G (IVIG) 1gm/kg/d x 2 days
+
*'''First choice in children:''' Intravenous Immunoglobulin G (IVIG) 1gm/kg/d x 2 days
#Anti-D (RhoGAM): patient must be Rh+ for it to work
+
*Anti-D (RhoGAM): patient must be Rh+ for it to work
#Transfusion (platelets)  
+
*Transfusion (platelets)  
##Indicated for life-threatening bleeding  
+
**Indicated for life-threatening bleeding  
##Transfuse only following first dose of methylprednisolone or IVIG  
+
**Transfuse only following first dose of methylprednisolone or IVIG  
###Holding transfusion until after first dose results in greater rise in platelet count
+
***Holding transfusion until after first dose results in greater rise in platelet count
#Estrogen for uterine bleeding: 25mg IV x1
+
*Estrogen for uterine bleeding: 25mg IV x1
  
 
==Treatment Indications==
 
==Treatment Indications==
 
===Adults===
 
===Adults===
#Plt >30K and asymptomatic: usually do not require treatment
+
*Plt >30K and asymptomatic: usually do not require treatment
#Plt count <30K: prednisone
+
*Plt count <30K: prednisone
#Plt <50K AND bleeding: prednisone
+
*Plt <50K AND bleeding: prednisone
#Life-threatening bleeding: IVIG, methylprednisolone, platelet transfusion
+
*Life-threatening bleeding: IVIG, methylprednisolone, platelet transfusion
  
 
===Children===
 
===Children===
#Platelet count >30K: usually do not require treatment
+
*Platelet count >30K: usually do not require treatment
#Platelet count <20K + significant bleeding: IVIG
+
*Platelet count <20K + significant bleeding: IVIG
#Platelet count <10K: IVIG
+
*Platelet count <10K: IVIG
#Life-threatening bleeding: IVIG, methylprednisolone, platelet transfusion
+
*Life-threatening bleeding: IVIG, methylprednisolone, platelet transfusion
  
 
==Disposition==
 
==Disposition==
#'''Admit:''' platelet count <20K or significant mucous membrane bleeding
+
*'''Admit:''' platelet count <20K or significant mucous membrane bleeding
#'''Discharge:''' platelet count >20K AND asymptomatic OR only minor petechiae
+
*'''Discharge:''' platelet count >20K AND asymptomatic OR only minor petechiae
  
 
==Complications==
 
==Complications==
#Rare: more common in elderly
+
*Rare: more common in elderly
##Intracerebral bleeding
+
**Intracerebral bleeding
##Severe GI bleeding
+
**Severe GI bleeding
  
 
==See Also==
 
==See Also==

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

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

Treatment Indications

Adults

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

Children

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

Disposition

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

Complications

  • Rare: more common in elderly
    • Intracerebral bleeding
    • Severe GI bleeding

See Also

ITP in Pregnancy

Source

  • Tintinalli
  • UpToDate