Immune Thrombocytopenic Purpura (ITP)

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Flashcards on Immune Thrombocytopenic Purpura (ITP), created by indysahota on 03/10/2013.
indysahota
Flashcards by indysahota, updated more than 1 year ago
indysahota
Created by indysahota almost 11 years ago
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Question Answer
ITP can be ____ or _____ acute, chronic
T/F: Acute ITP is typically seen in children True. Peak age is 2-6 years. 20-40 years for chronic ITP.
T/F: Gender plays a role in acute ITP False. There is no gender preference in acute ITP. There is for chronic ITP though. F > M (3:1)
History of recent infection in acute and chronic ITP Common in acute, rare in chronic
Onset of bleed in acute and chronic ITP Abrupt in acute, gradual in chronic
Duration of condition in acute and chronic ITP Usually weeks for acute and months to years for chronic
Spontaneous remissions in acute and chronic ITP >80% in acute and uncommon in chronic
T/F: Chronic ITP is the most common cause of isolated thrombocytopenia True
How is ITP diagnosed? Diagnosis of exclusion (chronic ITP): isolated thrombocytopenia and absence of underlying cause.
What is the pathophysiology of ITP? - Acquired immune-mediated disorder - Anti-platelet antibodies bind to platelet surface. This causes splenic destruction and clearance - Leads to impaired platelet production
What is the clinical presentation of ITP? - Can present with no symptoms - Minimal bruising to a serious bleed
What investigations would you order for ITP? Include expected results for ITP. - CBC and retic count: thrombocytopenia - PT and aPTT: normal (this is a primary hemostatic problem) - Blood smear: decreased platelets, giant platelets - Test for HIV and HCV (these are risk factors for ITP) - Bone marrow aspirate and biopsy: increased number of megakaryocytes (important in pts > 60yo to R/O myelodysplasia)
Outline the emergency management of ITP - Stop any drugs that are reducing platelet numbers or function, control BP, minimize trauma - Corticosteroids: prednisone - Antifibrinolytic: tranexamic acid - IVIG - Platelet transfusion: for life threatening-bleed - Emergency splenectomy
Outline the non-urgent management of ITP - In general platelet transfusions DO NOT work - First line: corticosteroids, IVIG, anti-D (for Rh+, non-splenectomized patients) - Second line: immunosuppresants (azathioprine, cyclophosphamide), rituximab (B cell immunosuppresant), danazol or vincristine, splenectomy
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