Idiopathic Thrombocytopenic Purpura (ITP) – Diagnosis and Treatment

Thrombocytopenia is due to immune destruction, in other words self destruction by the defense mechanism of the body of platelets. The antibody coated platelets are removed after they bind to Fc receptors on macrophages.

Idiopathic Thrombocytopenic Purpura (ITP) in children

The condition is frequently acute but self- limiting and may be followed by a viral infection or immunization. Bone marrow examination is not generally done unless treatment becomes essential on clinical grounds.

Idiopathic Thrombocytopenic Purpura (ITP) in adults

The appearance of ITP in adults is generally less acute than in children. Adult ITP is typically found in women and may be associated with other autoimmune diseases like SLE, thyroid disease and autoimmune hemolytic anemia (Evans' syndrome), in patients with chronic lymphocytic leukemia and solid tumors, and following infections with viruses such as HIV. Platelet auto antibodies are found in approximately 60-70% of patients, and are supposed to be present, although not demonstrable, in the rest of the patients.


Symptoms of Idiopathic Thrombocytopenic Purpura (ITP)


Major hemorrhage is unusual and found only in patients with severe thrombocytopenia. Easy bruising, purpura, bleeding from nose and excessive menstruation are common presentation. Nothing abnormal is usually found except the evidence of bleeding. Rarely spleen is found enlarged.

Diagnosis of Idiopathic Thrombocytopenic Purpura (ITP)

The only blood count abnormality is low platelet count. Normal or raised numbers of megakaryocytes are discovered in the bone marrow if bone marrow examination is performed. The detection of platelet auto antibodies is not vital for substantiation of the diagnosis, which usually depends on ruling out of other causes of excessive destruction of platelets.

Treatment of Idiopathic Thrombocytopenic Purpura (ITP)


Treatment of ITP Children

Children do not generally need treatment. Where this becomes essential on clinical grounds, high-dose prednisolone given for a very short course is usually effective. Intravenous immunoglobulin ( IgG) is kept reserved for very severe bleeding or the patient has to undergo surgery. Chronic ITP is exceptional and necessitates specialist management.

Treatment of ITP Adults

Patients with platelet counts greater than 300000000/L necessitate no treatment if not they are about to undertake a surgical procedure.

First-line therapy is oral corticosteroids 1 mg/kg body weight but intravenous IgG is helpful where a fast rise in platelet count is preferred, particularly before surgical procedure. High-dose corticosteroids as initial therapy is also preferred by some.

Second-line therapy is splenectomy. Majority of patients respond to this procedure, but a vast range of therapy is available for chronic ITP. These are high-dose corticosteroids, high-dose of intravenous IgG, intravenous anti-D, vinca alkaloids, danazol, immunosuppressive agents such as azathioprine, ciclosporine and dapsone. Specific monoclonal antibodies such as rituximab, as well as recombinant thrombopoietin are now also being used. Transfusions of platelet are kept for intracranial or other intense hemorrhagic situations, where emergency removal of spleen also helps.