Immune thrombocytopenic purpura (ITP) may occur in conjunction with a number of conditions. A diagnosis of idiopathic or primary ITP can be made ONLY if all of these diagnoses have been ruled out.

Systemic autoimmune disease:

(1) systemic lupus erythematosus (SLE)

(2) ulcerative colitis (UC)

(3) Sjogren' syndrome


Hematologic neoplasm or preneoplasm:

(1) B-cell malignant lymphoma

(2) myelodysplastic syndrome (MDS)

(3) chronic lymphocytic leukemia (CLL)



(1) malignant melanoma

(2) prostate adenocarcinoma

(3) pancreatic adenocarcinoma

(4) sarcomatoid carcinoma



(1) cytomegalovirus (CMV)

(2) viral hepatitis C (HCV) and viral hepatitis B (HBV)

(3) human immunodeficiency virus (HIV)

(4) infectious mononucleosis (EBV)

(5) other viral infection (rubella, parvovirus B19, mumps, varicella, etc)

(6) Helicobacter pylori



(1) adalimumab

(2) immune drug reaction


Some patients with an underlying cause may present with ITP prior to the diagnosis of the disorder. Therefore, a diagnosis of primary ITP requires a follow-up period during which there is monitoring for a previously occult disorder.


In a patient with a carcinoma it is important to exclude a chronic DIC before a diagnosis of ITP is made.

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