Immune thrombocytopenic purpura
Revision as of 05:06, 6 June 2015 by Rossdonaldson1 (talk | contribs) (Rossdonaldson1 moved page Idiopathic Thrombocytopenic Purpura to Idiopathic thrombocytopenic purpura)
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
Source
- Tintinalli
- UpToDate