Immune (or Idiopathic) Thrombocytopenic Purpura (ITP) is a fairly common condition which may occur in a child or adult, often following a viral infection. The patient may present with evidence of bleeding and isolated thrombocytopenia.
Platelet Count per µL |
Clinical Bleeding |
Stage |
> 20,000 per µL |
none |
I |
10,000 – 20,000 per µL |
skin only |
II |
10,000 – 20,000 per µL |
mucosal bleeding |
III |
< 10,000 per µL |
any bleeding |
IV |
Bleeding:
(1) skin: petechiae, purpura, ecchymoses
(2) mucosal: epistaxis, gingival bleeding, hematuria, menorrhagia, melena
(3) internal hemorrhage: intracranial hemorrhage, other
Stage |
Management Recommendation |
I |
observe; avoid antiplatelet agents and trauma, control blood pressure and any medical condition that increases the risk for bleeding |
II |
observe; treat prior to surgery or other situations where bleeding expected |
III |
treat |
IV |
treat |
Treatment options include:
(1) Platelet transfusions: These usually are ineffectual, since the platelets are quickly destroyed. Platelet transfusions are used only as a last ditch attempt to stop life threatening hemorrhage.
(2) Intravenous steroids: Prednisone or methylprednisolone are effective for initial control of the thrombocytopenia, but patients may have recurrence of disease when steroids are discontinued.
(3) Intravenous infusion of immune globulin (IVIG) concentrates: These are effective in many patients but the therapy is expensive.
(4) Anti-D immunoglobulin (Rhogam): Infusion of anti-D immunoglobulin has been approved for use in D-positive patients with ITP, but severe hemolytic anemia may occur.
(5) Vinca alkaloids: These have a variable benefit and are not routinely used.
(6) Plasmapheresis: Some people have tried plasma apheresis to remove the causative antibody, but IgG has a large volume of distribution and is difficult to completely remove.
(7) Immunosuppressant therapy: This is usually reserved for patients with severe disease refractory to other treatments.
(8) Splenectomy: This may be used in patients resistant to other forms of therapy.
An International Childhood ITP Registry (www.unibas.ch/itpbasel) has been developed to follow children with ITP.
Specialty: Hematology Oncology, Clinical Laboratory, Immunology/Rheumatology
ICD-10: ,