Immune Thrombocytopenic Purpura (ITP)

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