ITP Flashcards
Do you get lymphadenopathy ?
No
Do you get GI bleeding?
Rare
Do you get a big spleen?
Only in 3% which is about the same as normal pop
Where do you see the non palpable purpura?
Dependent areas
Less CT support like mucosa not soles of feet
What drugs can mimic?
Heparin Ampicillin Bactrim Panadol NSAIDs Vanc
Should you look for anti platelet ab?
No evidence that changes outcomes
When to do BM biopsy
Prior to splenectomy
If not responding to treatment
Plt over 60
Cutoff for starting Tx if asympt?
30
BM biopsy findings
Normal cellularity Normal erythropoesis MegaK increase or normal Left shift megaK Larger than normal but not giant
Note if absent mega K then its acquired pure megakaryocytic anaemia
Treatment?
Steroids and once counts increase taper over a few months
Ivig if need quick response
Second line splenectomy rituximab or romiplostom/eltrombopag if contraindicated to splenectomy or splenectomy failed
Splenectomy highest likelihood remission
TSAa support plt but do not induce remission
Rituximab less likely induce remission
Life threatening bleed
Cs
Ivig
Plt transfusion
Immunisation ?
At least 2 weeks prior for
S pneumo
N mening quadrivalent
Hib
Broad spectrum should include vanc and ceftriaxone because of worries about beta lactamase resistance in Hib
What bugs suscept post splenectomy ?
S pneumo the worst
HiB N mening S aureus Gram negs E. coli kleb salmonella capnotcystophagia from dog bites Malaria Babesia
What are wet purpura?
Purpura in mouth
Increased risk of intracranial bleed which usually only happens when plt under 10
What is the mechanism?
Reduced production platelets due to suppression mega K development
And
Increased destruction from antibodies against gp 2b3a
