18. ITP

Question 1

Primary ITP

Answer 1

isolated thrombocytopenia due to immune platelet destruction, idiopathic

Question 2

secondary ITP

Answer 2

Associated with underlying disease (SLE, HIV, CLL) or drug reaction

Question 3

clinical manifestations of immune thrombocytopenic purpura (ITP)?

Answer 3

mucocutaneous bleeding (ecchymoses and petechiae), bleeding from oral mucosa, GI bleeding
something identified incidentally on CBC
children–> acute disease, self limiting
adults–> chronic

Question 4

when do we do a bone morrow biopsy in ITP?

Answer 4

adults >60 y’ to rule out myelodysplasia

Question 5

how to diagnose Primary ITP?

Answer 5

diagnosis of exclusion
CBC: PLT<100,000
Peripheral smear: large platelets
bone marrow biopsy : ↑ megakaryocytes

rule out: viral serologies (HIV, HCV, HBV, EBV, CMV), H. pylori Ab’s, ANA, pregnancy, TSH

Question 6

1st line treatment for ITP

Answer 6

corticosteroids
IVIG
**Anti-Rh (D)- for Rh (D) positive patients with spleen

Question 7

2nd line treatment for ITP

Answer 7

• splenectomy (for persistent disease>6 months)
• Rituximab (for refractory disease)
• TPO receptor agonists (Romiplostim)- patients at risk of bleeding or splenectomy is CI
• other: immunosuppressants (cyclophosphamide), danazol, autologous HSCT