ITP Flashcards
for a typical patient with ITP (age 2-5 y), ITP prognosis?
resolves within 6 months (some–> 1 yr)
DDX for atypical ITP? (3)
drug-induced ITP SLE-associated ITP infections immunodef malignancy
give 4 red flags for alternative diagnosis
-constitutional sx
-bone pain
-recurrent thrombocytopenia
-poor response to tx
-LAD
-large liver/spleen
-child appears well
signs of chronic disease
-low hgb
-abnormal total WBC or ANC
-high MCV
-abnormal cellular morphology on smear
4 tx for ITP
observation
corticosteroids
IVIG
anti-D immunoglobulin (for Rh+ kids)
goal of ITP tx?
no active bleeding
mild ITP=?
no bleeding/mild bleeding
issues with observation as tx?
Longer period of activity restriction; anxiety while waiting for count recovery
other than observation 2, tx options for mild ITP
corticosteroids, IVIG
3 things to consider when deciding tx for mild ITP
family’s opinion, patient’s activity level, social issues
2 options for moderate ITP?
IVIG 0.8-1.0 g/kg
OR short course of corticosteroids= prednisone 4 mg/kg/day divided BID-QID x 4 days, max 150 mg/day WITHOUT taper vs. 2 mg/kg/day x 1-2 weeks WITH taper
3 side effects/disadvantages of IVIG
headache, n/v, fever, rash, hemolysis, IV placement, given in hospital, most $$ option
delay for plt response with IVIG?
2-7 days
AEs/disadvantages of corticosteroids?
mood changes, increased appetite/weight, gastritis, htn, poor taste may affect tolerance
delay for plt response to steroids?
48 hours
ITP tx option that is not recommended generally?
anti-D generally not considered first line/is associated with adverse effects
manifestations of severe bleeding in ITP?
worst 3%=prolonged epistaxis, GI bleeding or ICH
4 things to do for severe ITP pt
- Admission
- IV steroids
- (AND) IVIG
- TXA as adjunct: 25 mg/kg/dose TID-QID to max 1500 mg per dose
moderate ITP pt: what if doesn’t respond to your initial therapy?
Switch from steroids-> IVIG or vice-versa
under what circumstances would you transfuse plts for ITP pt?
Only give plt transfusion for acute, life-threatening bleeds or in children requiring immediate surgery
relapse rate in ITP?
1/3 (even with initial response)
how long does ITP require follow-up?
Continue until plt counts have recovered (must be <100 to qualify as ITP)
make sure to do what when following ITP pt? (3)
Do phys exam, plt count, anticipatory guidance re: bleeding
When plts low/evidence of bleeding: avoid contact sports/activities that may cause injuries (esp head injuries!)
