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Idiopathic Thrombocytopenic Purpura (ITP):

(HIGH YIELD NOTES FOR |MBBS|NEETPG|NEXT|INICET|FMGE)

 

A relatively common cause of thrombocytopenia.

IgG antibodies are formed against the patient’s platelets.

Bone marrow production of platelets is , with megakaryocytes in the marrow.

The most common immunologic disorder in women of childbearing age

 

 

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Presentation:

Patients often feel well and present with no systemic symptoms. They may have minor bleeding, easy bruising, petechiae, hematuria, hematemesis, or melena.

Bleeding is mucocutaneous.

Generally there is no splenomegaly.

ITP is associated with a range of conditions, including lymphoma, leukemia, SLE, HIV, and HCV. Presentation is as follows:

Acute: Abrupt onset of hemorrhagic complications following a viral illness. Commonly affects children 2–6 years of age, with males and females affected equally.

Chronic: Insidious onset that is unrelated to infection. Most often affects adults 20–40 years of age; females are 3 times more likely to be affected than male

 

 

Diagnosis:

  • A diagnosis of exclusion, as the test for platelet-associated antibodies is a poor one.
  • Once other causes of thrombocytopenia have been ruled out, a diagnosis can be made on the basis of the history and physical, a CBC, and a peripheral blood smear showing normal RBC morphology.
  • Most patients do not require bone marrow biopsy, which would show ↑ megakaryocytes as the only abnormality.

 

 

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Treatment:

  • Most patients with acute childhood ITP spontaneously remit, but this is rarely the case with chronic ITP.
  • Treatment is reserved for patients with symptomatic bleeding.
  • Those with platelet counts > 20,000/mm3 are generally asymptomatic.
  • Platelet transfusions are of no benefit, as patients’ IgG levels will lead to destruction of platelets.
  • The main therapies are corticosteroids, high-dose gamma globulin (IVIG), and splenectomy. Most patients respond to corticosteroids, but if they cannot be tapered after 3–6 months, splenectomy should be considered.
  • In pregnant patients, severe thrombocytopenia may occur in the fetus.
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