Idiopathic Thrombocytopenic Purpura
- Idiopathic thrombocytopenic purpura (ITP) is thrombocytopenia without apparent cause or abnormalities in other cell lines
- Incidence is ∼2–5/100,000/yr – may be an underestimate owing to undetected, subclinical cases
- Acute ITP:
- 1/2 of cases involve children
- 80% of children recover within 8 wk with or without therapy
- Adult recovery is delayed and requires specific therapy to achieve remission
- Chronic ITP:
- Platelets <150,000 for >6 mo following a diagnosis of ITP
- Occurs mostly in adults
- Young women are most susceptible in adult-onset ITP
- Characterized by variable response to corticosteroids and other immune suppressants
- 60–70% respond to splenectomy
- Chronic refractory ITP:
- Platelet counts may often wax and wane
- Often do not respond to therapy
- No clear optimal course of treatment
- ITP appears to run in families, as do variations in response to corticosteroids for treatment
- Autoantibodies produced by B-cells and plasma cells cause immune-mediated destruction of circulating platelets
- Macrophages in spleen and liver mediate destruction of platelets via IgG autoantibodies
- IgM and IgA rarely have been seen
- Some patients do not possess autoantibodies, suggesting a role for T-cell–mediated cytotoxicity
- C3 and C4 complements have also been shown to play a role in patients that lack autoantibodies
- Poor platelet production may also play a role especially in chronic or refractory cases of ITP
- Eradication of Helicobacter pylori can sometimes be associated with platelet recovery (unclear mechanism)
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Schaider, Jeffrey J., et al., editors. "Idiopathic Thrombocytopenic Purpura." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307383/1.0/Idiopathic_Thrombocytopenic_Purpura.
Idiopathic Thrombocytopenic Purpura. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307383/1.0/Idiopathic_Thrombocytopenic_Purpura. Accessed May 29, 2023.
Idiopathic Thrombocytopenic Purpura. (2016). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (5th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307383/1.0/Idiopathic_Thrombocytopenic_Purpura
Idiopathic Thrombocytopenic Purpura [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2023 May 29]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307383/1.0/Idiopathic_Thrombocytopenic_Purpura.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Idiopathic Thrombocytopenic Purpura ID - 307383 ED - Barkin,Adam Z, ED - Shayne,Philip, ED - Rosen,Peter, ED - Schaider,Jeffrey J, ED - Barkin,Roger M, ED - Hayden,Stephen R, ED - Wolfe,Richard E, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307383/1.0/Idiopathic_Thrombocytopenic_Purpura PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -