Idiopathic Thrombocypenic Purpura (ITP)
- Idiopathic thrombocytopenic purpura is thrombocytopenia without an underlying
causative disease or offending medication.
- Platelets are removed prematurely
by reticuloendolethial system.
- Peak incidence occurs in children (2–6 years
old) and adults (20–50 years old).
- Acute ITP is more common in children and
chronic ITP is more common in adults.
- Platelet counts of <20,000/mm3 may
cause life-threatening hemorrhage.
- Accelerated platelet destruction mediated by
- Acute: post-viral (usually 1-2 wks after)
- Chronic: autoimmune, collagen vascular or
malignant disease underlying (SLE, CLL, lymphoma)
- Sudden, severe onset
- Usually children 2-6 yo
- 1-3 wks after viral illness
- Petechiae to ecchymosis, epistaxis, GI
bleed, hematuria, retinal hemorrhage, ICH
- Insidious onset (>6 mo)
- Spontaneous remission uncommon
- Females 20-50 yo
- Epistaxis, menorrhagia, easy bruising
- Isolated thrombocytopenia on CBC
- Peripheral smear with a small number of well-granulated
- Bone marrow biopsy shows no primary bone marrow disorder.
- Treatment is reserved for severe bleeding with platelets <50,000/mm3 or
platelet count <10,000/mm3 without bleeding.
- For children:
- Treatment is usually conservative since the majority have a
- Children should avoid physical activity or NSAIDs
- If serious: IV IgG,
splenectomy, platelet transfusions
- If actively bleeding:
- Glucocorticoids can achieve complete
remission (if bone marrow bx planned : must do prior)
- Otherwise, spontaneous resolution
weeks to months
- Chronic: Prednisone
splenectomy, +/- immunosuppression (cyclophosphamide, azathioprine or
vincristine), danazol 200
mg PO tid, IV IgG 0.4
g/kg IV qd x 5d