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B - Paediatrics MANAGEMENT > Immune Thrombocytopenic Purpura > Flashcards

Immune Thrombocytopenic Purpura Flashcards

1
Q

What is thrombocytopenia?

A

A platelet count of less than 150x10^9/L.

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2
Q

What dictates the risk of bleeding in thrombocytopenia?

A

The severity

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3
Q

What is considered to be severe thrombocytopenia?

A

Platelets <20 x 10^9/L

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4
Q

What risk is severe thrombocytopenia associated with?

A

Spontaneous bleeding

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5
Q

What is considered to be moderate thrombocytopenia?

A

Platelets 20-50 x 10^9/L

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6
Q

What risk is moderate thrombocytopenia associated with?

A

Excess bleeding during operations or trauma

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7
Q

Is there a risk of spontaneous bleeding with moderate thrombocytopenia?

A

Low risk

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8
Q

What is considered to be mild thrombocytopenia?

A

50-150 x 10^9/L

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9
Q

What risk is mild thrombocytopenia associated with?

A

Low risk of bleeding, unless there is a major operation or severe trauma

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10
Q

What is the most common cause of thrombocytopenia in childhood?

A

Immune thrombocytopenic purpura

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11
Q

What is the incidence of ITP in children?

A

About 4 in 100,000 / year

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12
Q

What is ITP caused by?

A

Destruction of circulating platelets by anti-platelet IgG antibodies

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13
Q

What might the reduced platelet count be associated with in ITP?

A

A compensatory increase in megakaryocytes in the bone marrow

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14
Q

What are the risk factors for ITP?

A
  • Female gender

- Recent viral infections

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15
Q

Give 3 viral infections that ITP may follow?

A
  • Mumps
  • Measles
  • Respiratory infection
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16
Q

When do most children with ITP present?

A

Between the ages of 2 years and 10 years

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17
Q

What does the onset of ITP often follow?

A

1-2 weeks after viral infection

18
Q

How long is the history of ITP?

A

In the majority of children, there is a short history of days or weeks

19
Q

What are the symptoms of ITP?

A
  • Petechiae
  • Purpura
  • Superficial bruising
  • Epistaxis and other mucosal bleeding
20
Q

What kind of diagnosis is ITP?

A

Diagnosis of exclusion

21
Q

What is the importance of ITP being a diagnosis of exclusion?

A

Careful attention must be paid to history, clinical features, and a blood film to ensure a more sinister diagnosis is not missed

22
Q

What are the differential diagnoses of ITP?

A
  • Congenital conditions
  • Acute leukaemia or aplastic anaemia
  • SLE
23
Q

What congenital conditions are differentials for ITP?

A
  • Wiskott-Aldrich

- Bernard-Soulier syndrome

24
Q

Why is ITP not always concerning?

A

In about 80% of children, the disease is acute, benign, and self limiting, usually remitting spontaneously within 6-8 weeks

25
Q

Where can most children with ITP be managed?

A

At home, without need for hospital admission

26
Q

Why is treatment for ITP controversial?

A

Because most children do not need any therapy, even if the platelet count is less than 10 x 10^9/L

27
Q

When should treatment for ITP be given?

A

If there is any evidence of major bleeding

28
Q

Give two examples of sources of major bleeding in ITP?

A
  • Intracranial

- Gastrointestinal

29
Q

What are the treatment options for ITP?

A
  • Oral prednisolone
  • IV anti-D
  • IV immunoglobulins
  • Platelet transfusions
30
Q

What is the problem with treatments for ITP?

A

All the treatments have serious side effects

31
Q

What are platelet transfusions used for in ITP?

A

Reserved for life-threatening haemorrhage

32
Q

Why are platelet transfusions reserved for life threatening haemorrhage in ITP?

A

As they only raise platelet count for a few hours

33
Q

What general measures should be taken when a child with ITP has a very low platelet count?

A
  • Parent needs immediate 24-hour access to hospital

- Child should avoid trauma, e.g. contact sports

34
Q

What is chronic ITP?

A

When the platelet count remains low for 3 months after diagnosis

35
Q

What % of children with ITP will have chronic ITP?

A

20%

36
Q

What is the treatment for chronic ITP in the majority of children?

A

Mainly supportive

37
Q

When is drug treatment offered to children with chronic ITP?

A

Children with persistent bleeding that affects daily activity or impairs quality of life

38
Q

Is it common for children with chronic ITP to have significant bleeding?

A

No, it is rare

39
Q

What treatments are available for chronic ITP?

A
  • Rituximab
  • Thrombopoietic growth factors
  • Splenectomy
40
Q

Give an example of a complication of ITP

A

Intracranial bleeding

B - Paediatrics MANAGEMENT (106 decks)

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