ITP (Immune Thrombocytopenic Purpura)

Outline

Background

• Immune destruction of platelets, diagnosis of exclusion once finding thrombocytopenia

• Platelet transfusions ineffective as body will just destroy them again

• Associations: HIV, Viral Hepatitis AE 

Assessment

History

• Usually asymptomatic

• Platelet bleeding

  • Mucosal bleeding- gums

  • Excessive bleeding after minor procedures

  • Menorrhagia

Examination

• Usually nil

• Petechial rash

Investigations

• Thrombocytopenia

• HIV, HBV, HCV

• FBC ? haematological cancers often affect multiple cells lines

• Consider AUSS ?cirrhosis, protein electrophoresis ?myeloma, ANA/ ENA ?connective tissue disorders; 

Diagnosis

Diagnostic criteria: thrombocytopenia with differentials excluded

Differentials: TTP, HUS, DIC, HIT, PNH; Liver Cirrhosis 

Management

1. Prednisolone or IVIG if acutely unwell

2. Failure to respond to prednisolone: IVIG, MMF, rituximab

3. Splenectomy

Med Reg Notes

Splenectomy Vaccinations

Pneumococcal vaccine 4-6 weeks prior to splenectomy but shouldn't cause a delay to splenectomy or chemo-radiotherapy. 

Encapsulated organisms

• Streptococcal pneumonia

• Hemophilus influenza

• Neisseria Meningitidis 

References & Resources

1. https://www.thebloodproject.com/learning-resource-page/

Written 2024