Hematology Clinical Resource Area: Idiopathic Thrombocytopenic Purpura (ITP) Overview

This is an autoimmune hematological disorder in which an individual does not form clots as the body needs. This failure to clot in the presence of bleeding is related to thrombocytopenia. Purpura known as purple bruises is bleeding from veins under the skin surface. ITP patients may also experience petechia of the extremities.

There are two known types of ITP; acute and chronic. Much as there names indicate acute is short in duration and chronic is a prolonged disease state. Most generally ITP is considered chronic when the duration exceeds 6 months.

Acute ITP is prevalent in the younger population. This state is frequently related to a viral illness. The disorder generally resolves without intervention.

Chronic ITP is more often seen in adult patients. Although known childhood cases exist. This hematological condition is more prevalent to females than males; 2-3 times.

Treatment of the disorder is related to severity of bleeding episodes. Treatment for children and adults is similar. First line treatment is corticosteroids. When this in ineffective or alternative treatment is indicated such as in the instances of prolonged or severe bleeding, patients may receive IV immune globulin. IN some cases patients may require a spleenectomy to resolve autoimmune component of platelet destruction. Drug history with subsequent discontinue of medications may resolve thrombocytopenia.

Diagnosis: Patients with ITP may present with bleeding symptoms such as gum line bleeding, nosebleeds, heavy menstrual bleeding, bruising or frank blood evident in urine or stools. Frank intracranial bleeding is rare, but is life threatening when present.

Diagnostic work up includes thorough history and extensive physical exam. Patients will have a CBC with manual differential as well. Platelet counts are critical with analysis of past counts. A bone marrow aspirate may be necessary to confirm adequate production of platelets. An extensive drug review including over the counter and herbal/vitamin therapies is essential.

Disease Overview: ITP in pregnancy requires little to no therapies without ill or harmful effects to the baby. In the event of pregnancy and very low platelet counts, treatment will be provided. The risk of bleeding or hemorrhage at delivery should be assessed and monitored.

ITP in children generally resolves in weeks to months. These kids are provided routine follow up assessments including platelet counts and physical assessment. Any incidence of bleeding should be investigated and assessed. Treatment is started for continued low platelet count or bleeding episodes. Patients with ITP are instructed to avoid Aspirin, Ibuprofen and other platelet altering agents. Attempts should be made to avoid injury or contact sports.

National Heart Lung and Blood Institute; Diseases and Conditions Index
DCI Home: Blood Diseases: Idiopathic Thrombocytopenic Purpura