ITP

Question 1

What is ITP?

Answer 1

• Acquired, immune-mediated thrombocytopenia

Question 2

Pathophys of ITP

Answer 2

• Immune mediated shortened circulating platelet survival

- In the absence of other disturbances of haemostasis/coagulation

Question 3

Categories of ITP and differences

Answer 3

1. Acute (~ 90%):
   - self limiting disease (sometimes preceded by a viral syndrome)
   - spontaneous resolution within 6 months (usually within 2 months)
   - Relapsing: can redevelop, usually precipitated by viral episode
2. Chronic (~ 10%):
   - does not remit within 6 months
   - Hx of bruising from infancy

Question 4

Clinical features of ITP, and important non-features of ITP.

Answer 4

• Most only with bruising and petechiae
• Sometimes:
  
  • oral bleeding, epistaxis, rectal bleeding or haematuria.
• Nil:
  
  • Pallor/anaemia
  • Hep/splenomegaly

Question 5

What other causes of thrombocytopaenia must be excluded?

Answer 5

• Acute leukaemia
• Other marrow infiltrative conditions
• Aplastic anaemia

Question 6

Initial Mx of thrombocytopaenia

Answer 6

• Either a) no treatment b) oral steroids.
• Spontaneous plt count recovery usually within 4-6 weeks, steroids makes it occur quicker (but no effect on morbidity/mortality)
• Need parental reassurance and education

Question 7

What Mx might be needed in chronic ITP?

Answer 7

Splenectomy

Question 8

What is a rare complication of ITP?

Answer 8

The incidence of intracranial haemorrhage is much less than 1%, and very rare in true uncomplicated ITP.