Idiopathic Thrombocytopenic Purpura ( ITP)

Question 1

Definition of Idiopathic Thrombocytopenic Purpura ( ITP)

Answer 1

Autoimmune disorder characterized by low platelet count (thrombocytopenia) due to the destruction of platelets by the immune system. Originally thought to be autoantibodies against GP-IIB/IIIa, but actually a combo increased platelet degradation, antibodies against megakaryocytes. and relatively low TPO.

Question 2

Causes of Idiopathic Thrombocytopenic Purpura ( ITP)

Answer 2

Abnormal immune response in which the body’s immune system mistakenly targets and destroys platelets. In some cases, ITP may be preceded by a viral infection, such as a respiratory or gastrointestinal infection, suggesting a potential triggering event. It can affect both children and adults, with different characteristics and potential underlying causes.

Question 3

Pathomechanism of Idiopathic Thrombocytopenic Purpura ( ITP)

Answer 3

In ITP, the immune system produces autoantibodies (specifically, antiplatelet antibodies) that bind to platelets, leading to their destruction by macrophages in the spleen and liver. The reduced platelet count affects the blood’s ability to form clots, resulting in increased bleeding and bruising tendencies.

Question 4

Symptoms of Idiopathic Thrombocytopenic Purpura ( ITP)

Answer 4

Easy or excessive bruising: The skin may bruise easily or with minimal trauma.

Petechiae: Small, pinpoint-sized red or purple spots that occur on the skin or mucous membranes.

Prolonged or excessive bleeding: This can manifest as nosebleeds, bleeding gums, prolonged or heavy menstrual bleeding in women, or in rare cases, internal bleeding (e.g., gastrointestinal bleeding).

Fatigue and weakness: Due to the decreased number of platelets and potential bleeding-related anemia.

Question 5

Diagnosis of Idiopathic Thrombocytopenic Purpura ( ITP)

Answer 5

Complete blood count (CBC): To assess platelet count and rule out other blood-related disorders.

Blood smear: To examine the size and appearance of platelets.

Bone marrow aspiration or biopsy: In some cases, this may be performed to rule out other potential causes or evaluate the bone marrow’s response.

Medical history and physical examination: To evaluate symptoms, ruling out other potential causes, and assess for bleeding tendencies.
*Isolated thrombocytopenia: < 100 G.
*Helpful to distinguish Henoch-Schonlein purpura (HSP has normal platelets + abdominal pain + hematuria + bloody stool).

Question 6

Treatment of Idiopathic Thrombocytopenic Purpura ( ITP)

Answer 6

Corticosteroids: These may be prescribed to suppress the immune system and reduce platelet destruction.

Intravenous immunoglobulin (IVIG): Infusions of immunoglobulins can temporarily raise the platelet count.

Immunosuppressive drugs: These medications may be prescribed in cases of chronic or severe ITP that does not respond to other treatments.

Thrombopoietin receptor agonists: These drugs stimulate the production of platelets in the bone marrow.

Splenectomy: In cases of chronic or severe ITP that does not respond to other treatments, surgical removal of the spleen (splenectomy) may be considered.

*Chronic resistant cases may need anti-Rh, splenectomy, rituximab, or TPO mimetics