Idiopathic Thrombocytopenic Purpura

- a.k.a Autoimmune Thrombocytopenic Purpura / Primary Immune Thrombocytopenic Purpura

- diagnosis of exclusion

- increase in peripheral platelet destruction due to presence of IgG autoantibodies on the platelet surface
- where? liver (Kupffer cells) and spleen (splenic macrophages)

2 types

1. acute - occurs typically in children, usually following infection, lasts less than 6 months
2. chronic - occurs in adults, lasts for more than 6 months

Ask about 

- drug-induced thrombocytopenia (e.g heparin, alcohol, quinolones, sulfonamides)

- auto-immune disease

- liver disease

- bleeding sx (epistaxis, hematochezia, menorrhagia, bruises, gum bleeding)

Phy

purpura - 

petichea - less than 3mm

Dx : TTP, malignancy (leukemia), drug-induced, autoimmune disease, 

Ivx : 

1. FBC - isolated Thrombocytopenia

2. PBF - megakaryocytes

3. Coag Profile - Normal

4. BMA - megakaryocytes

5. CT Scan of the Brain - if suggestive of ICB

Tx

- give IV corticosteroids (prednisone / methylprednisolone)

- IV Immunoglobulin

- platelet infusion if  only in severe bleeding (EMERGENCY)

- if fails, splenectomy

Mortality is due to uncontrolled bleeding

advice to parents - not to give patients with aspirin, ibuprofen, naproxen, inform the school on what to be done should the child gets bleeding d/t trauma at school, 

ITP is not hereditary

reference : http://emedicine.medscape.com/article/779545-medication