Haematology- Idiopathic Thrombocytopenic Purpura

Question 1

What is idiopathic thrombocytopenic purpura?

Answer 1

Spontaneous low platelet count which causes a purpuric rash

Question 2

What causes ITP?

Answer 2

Type II hypersensitivity reaction

Production of antibodies that target and destroy platelets, can be triggered by viral infection etc.

Question 3

How does ITP present?

Answer 3

Children under 10
Recent viral illness
24-48 hour symptom onset
Bleeding - gums, epistaxis or menorrhagia
Bruising
Petechial or purpuric rash - bleeding under skin

Question 4

How is ITP diagnosed?

Answer 4

Confirmed by urgent fbc for platelet count

Other FBC values should be normal

Question 5

What other causes of thrombocytopenia should be excluded?

Answer 5

Heparin induced thrombocytopenia
Leukaemia

Question 6

How is ITP managed?

Answer 6

Usually no treatment is required and patients monitored until platelets return to normal

Treatment may be needed if patient is actively bleeding or severe thrombocytopenia (platelets under 10)

Question 7

How many patients with ITP resolve within 3 months?

Answer 7

70%

Question 8

What medications are used to treat ITP?

Answer 8

Prednisolone
IV immunoglobulins
Blood transfusions (if needed)
Platelet transfusions (only work temporarily)

Question 9

Why do platelet transfusions only work temporarily?

Answer 9

Antibodies against platelets being destroying transfused platelets as soon as they are infused

Question 10

What key education and advice should be given to parents?

Answer 10

• Avoid contact sports
• Avoid IM injections and LPs
• Avoid NSAIDs, aspirin and blood thinning medications
• Advice on nosebleed management
• Seek help after injury that may cause internal bleeding - car accident, head injuries

Question 11

What are the complications of ITP?

Answer 11

Chronic ITP
Anaemia
Intracranial and subarachnoid haemorrhage
GI bleeding