ITP (Immune Thrombocytopenic Purpura)

Exam Cram

• Moa: immune destruction of platelets

• Diagnosis: thrombocytopenia with known causes excluded (diagnosis of exclusion)

• Acute Management: prednisolone, 

• Longer term mx: splenectomy

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

• Mucosal bleeding- gums

• Excessive bleeding after minor procedures

• Menorrhagia

Examination

• Petechial rash

Investigations

• Thrombocytopenia

• Normal baseline bloods: haemoglobin, white cells, creatinine, LFTs,

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