Immune thrombocytopenic purpura

Question 1

Types of ITP

Answer 1

primary - unknown cause
secondary - paraneoplastic syndromes, infections, systemic autoimmune diseases

Question 2

what is Immune thrombocytopenia purpura?

Answer 2

increased breakdown of platelets usually due to autoimmune response

Question 3

risk factors for ITP

Answer 3

female
<10, >65

Question 4

signs of ITP

Answer 4

petechiae (small purple spots on lower limbs)
haemorrhagic bullae (small spots on oral/mucosal surfaces)
bleeding gums

no systemic autoimmune disease signs/ no splenomegaly (hepatits)

Question 5

investigations for ITP

Answer 5

FBC - low platelets (<100 x 10^9)
peripheral blood smear

exclude secondary causes
HIV serology
Hep C serology
TFTs (hypo/hyper) - rare

Question 6

acute management of ITP (severe bleeding)

Answer 6

IV immunoglobulins
platelet transfusions
corticosteroids (prednisolone)

Question 7

complications of ITP

Answer 7

intracranial haemorrhage
life threatening bleeding => Emergency treatment includes combination therapy with platelet transfusion, intravenous corticosteroids, and intravenous immunoglobulin.
treatment complications
- long term corticosteroids => osteoporosis, glucose intolerance, and increased risk of infection
- transfusion-transmitted diseases
- long term thrombopoiten mimetics => increased risk of thrombotic events during treatment

Question 8

prognosis of ITP

Answer 8

good 95% of patients respond to treatment

Question 9

chronic management of ITP (children + adults)

Answer 9

children
1. myclophenate 2.rituximab 3. splenectomy

adults
1. low dose corticosteroids/ repeated IVIG
2. myclophenate
3. splenectomy