Idiopathic Thrombocytopenic Purpura (ITP) – Kaufman

ITP is an acquired disorder of platelets:  consider as either increased destruction or decreased production.

Classified as primary (a dx of exclusion) vs secondary.

Etiology:  Caused by anti-platelet IgG directed against membrane proteins of the platelets.

Inciting events:  infection vs immune alteration..

Incidence:  highest in children, and increased incidence with increased age in adult.

DDx:  drug-induced (heparin, quinine, sulfas, APAP, cimetidine, NSAIDs, ampicillin, piperacillin, vancomycin, GIIIPII inhibitors), chronic pancreatitis, sepsis with DIC, intracellular parasites, hypersplenism, nutritional deficiencies, EtOH use, pregnancy, pre-eclampsia/HELLP syndrome, cancer and myeloplastic disorders, thrombotic microangiopathies, APLA syndrome…and many, many more!

Hx:  Ask about recent illness, new meds.

Clinical manifestations:  bleeding only in 2/3 (serious <10K); petechiae; purpura (“wet purpura” – involvement of mucus membranes, a marker for more serious illness); epistaxis; severe hemorrhage (ICH, GI).

Workup:

  • Blood smear
  • HIV
  • HCV
  • Coags
  • LFTs
  • Rheum workup (ANA, RF) if symptoms suggestive
  • H pylori if clinically suggested
  • TSH if clinically suggested
  • Bone marrow biopsy – if severe disease or no clear cause

ITP is NOT associated with abnormal hematologic morphology or coag abnormalities – if abnl RBCs, WBCs or coags, think something other than ITP!

Treatment:

  • Hospitalize with severe bleeding or if platelets < 30K
  • Heme consult
  • Platelet transfusion
  • Glucocorticoids
  • IVIG
  • Splenectomy for severe or recurrent disease
  • Rituximab for severe disease
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