Immune Thrombocytopaenic Purpura
Also known as idiopathic thrombocytopaenic purpura.
Autoimmune destruction of platelets by the monocyte-macrophage system (predominantly in the spleen), divided into:
- Primary ITP
No inciting cause. - Secondary ITP
Epidemiology and Risk Factors
Pathophysiology
Aetiology
Clinical Features
- Mucocutaneous bleeding
Assessment
History:
Exam:
Investigations
Bedside:
Laboratory:
Imaging:
Other:
Diagnostic Approach and DDx
Diagnosis of exclusion, requires:
- Isolated thrombocytopaenia
- No other underlying cause
Management
- Corticosteroids
- Consideration of splenectomy
- Achieve a safe (rather than normal) platelet count
Resuscitation:
Specific therapy:
- Pharmacological
- Dexamethasone 40mg daily for 4 days
Indicated for:- Severe thrombocytopaenia
<10×109/L. - Uncontrolled bleeding
- Severe thrombocytopaenia
- IVIG
Major bleeding not responding to corticosteroids. - Thrombopoietin receptor agonists
- Romiplostim
- Eltrombopag
- MAB
- Rituximab
- Dexamethasone 40mg daily for 4 days
- Procedural
- Splenectomy
- Physical
Supportive care:
Disposition:
Preventative:
Marginal and Ineffective Therapies
Anaesthetic Considerations
Complications
Prognosis
Key Studies
References
- Bersten, A. D., & Handy, J. M. (2018). Oh’s Intensive Care Manual. Elsevier Gezondheidszorg.
- Kappler S, Ronan-Bentle S, Graham A. Thrombotic Microangiopathies (TTP, HUS, HELLP). Emergency Medicine Clinics of North America. 2014;32(3):649-671. doi:10.1016/j.emc.2014.04.008