ITP Flashcards
What platelet count can signal ITP
<100
What is ITP
Increased immune destructon of platelets/reduced production of platelets
Diagnosis of exclusion - lab tests cant confirm
What suggests ITP
Response to ITP specific therapy - still cant differentiate primary ad secoandry
Differentials for ITP
Liver disease
Splenomegaly
Drugs
Bone marrow diseases
Other TPs
Inherited TP
What can cause immune thrombocytopenia
Infections - HIV, HCV,HBV
AI/immunodef disorders - CVLD, SLE, APS
Maliganncy eg lymphoproliferative disorders
Drugs causing thrombocytopenia
Heparin, alemtuzumab
PD-1 inhibitors
Abciximab
Valproate
Alcohol abuse
QUININE
Environmental toxins
Chemotherapy
Bone marrow diseases causing TP
Myedoplastic syndromes
Leukaemias
other malignancies
Metastaic disease
Myeofibrosis
Aplastic anaemia
Megaloblastic anaemia
Gaucher disease
Other thrombocytopenic disorders
DIC
TTP
HUS
evans syndrome
Inherited TPs
TAR syndrome
Radioulnar synostosis
Congenital amegakaryocytc TP
Wiskott-aldrich syndrome
MYHP-related disease
Bernard soulier syndrome
Type IIB VWD
Platelet type VWD
Investigations
Hepatitis, HIV screen, viral serology
LFTs + coag screen, blood film
Haemotological findings in ITP
Platelets <100 x109
Hb and WBC normal
Large platelets on blood film
Normal ATP/TTP
Increased megakaryocytes on bone+- marrow biopsy
Presentation in children ITP
Common post viral illness or vaccination
Abrupt onset - no treatment needed - weeks to months, wait and watch, minimising trauma risk
Adult presentation ITP
Chronic course
Treatment needed - remission self rare -if platelets <20
Secondary to connective tissue disorders, lymphoproliferatie disorders (20%)
Pregnancy <80 consider
Bleeding symtpoms in ITP
Muscosal bleeding - epistaxis, gums, blood blisters oral, menorrhagia, brusises and petechiae - eyelid, lower leg ->purpura
Trauma related bleeding
Intracranial bleeding - may occur spontaneously if severe
Severe thrombocytopenia
<20 x 109 platelets
