Immune thrombocytopenic purpura
Background
- Acquired autoimmune disease resulting in destruction of platelets
- Because circulating plts are functional, life-threatening bleeding only once plt <10K
- Types
- Acute
- More common among younger children
- Affects men/women equally
- Resolves in 1-2mo
- Chronic
- Lasts >3mo
- More common in adults and women
- Rarely remits spontaneously or with tx
- More likely to have an ynderlying disease or autoimmune disorder (e.g. SLE)
- Acute
Clinical Features
- Petechiae
- Epistaxis, ginigival bleeding, menorrhagia
Diagnosis
- Diagnosis of exclusion
- Must differentiate from chronic ITP, which suggests an underlying disorder
- CBC shows normal cell lines except for the platelets (may have mild anemia)
Treatment
Options
- Corticosteroids
- First-line in adults
- Prednisone 60-100 mg/d w/ taper after count reaches normal
- Methylprednisolone 30mg/kg/d IV x3d (for life-threatening bleeding)
- IVIG
- First-line in children
- 1gm/kg/d x2d
- Anti-D (RhoGAM)
- Pt 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 plt count
- Estrogen (uterine bleeding)
- 25mg IV x1
- Corticosteroids
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
- Plt count >30K: Usually do not require treatment
- Plt count <20K + significant bleeding: IVIG
- Plt count <10K: IVIG
- Life-threatening bleeding
- IVIG, methylprednisolone, platelet transfusion
Disposition
- Admit:
- Pts w/ plt count <20K or those who have significant mucous membrane bleeding
- Discharge:
- Plt counts >20K AND asymptomatic or have only minor petechiae
Complications
- Rare; more common in elderly
- Intracerebral bleeding
- Severe GI bleeding
Source
Tintinalli