Medicine & USMLE

Immune Thrombocytopenic Purpura (ITP)

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Platelet Disorders
  1. Platelet Plug Formation
  2. Von Willebrand Disease
  3. Bernard-Soulier Syndrome
  4. Glanzmann Thrombasthenia
  5. Immune Thrombocytopenic Purpura (ITP)
  6. Thrombotic Thrombocytopenic Purpura (TTP)
  7. Hemolytic Uremic Syndrome (HUS)
  8. Disseminated Intravascular Coagulation (DIC)

Summary

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Key Points

  • Immune Thrombocytopenic Purpura (ITP)
    • Pathogenesis
      • Destruction of normal platelets by spleen
        • Usually due to anti-GpIIb/IIIa antibodies
        • Splenic macrophages target and phagocytose platelets
        • Idiopathic or secondary to autoimmune disorders (e.g. SLE), viral illnesses (e.g. HIV, HCV), malignancy (e.g. CLL), or drug reactions
    • Presentation
      • Mucocutaneous bleeding
        • Gingival bleeding, menorrhagia, petechiae, epistaxis, easy bruising
    • Diagnosis
      • Decreased platelet count (thrombocytopenia)
        • Quantitative defect in platelets; quality of platelets is unaffected
        • Isolated thrombocytopenia is often the only symptom of disease
      • Increased megakaryocytes on bone marrow biopsy
        • Intact compensatory response to platelet destruction
      • Increased bleeding time
        • Due to decreased platelet count
    • Treatment
      • Steroids
      • IVIG
      • Rituximab
      • TPO receptor antagonists (e.g. eltrombopag, romiplostim)
      • Splenectomy for refractory cases