Idiopathic Thrombocytopenic

Purpura

ITP
nadersmadi@hotmail.com
 Introduction
• Idiopathic thrombocytopenic purpura
(ITP), also called immune
thrombocytopenic purpura, is a
bleeding disorder in which your blood
has difficulty clotting due to an
unusually low number of platelets.
Platelets (thrombocytes) are colorless
blood cells that stop blood loss by
clumping together at the site of a
blood vessel injury and forming plugs
in vessel holes.
 Introduction
• People with idiopathic thrombocytopenic
purpura, because of their low platelet
count, tend to bruise easily and bleed
longer when injured. Nosebleeds and
bleeding gums also are common.
• Idiopathic thrombocytopenic purpura is
often divided into two categories: acute
and chronic. Acute ITP is the most
common form and occurs most
frequently in children, typically after a
viral infection. It usually goes away on its
own within six months. Chronic ITP lasts
longer than six months and is more
 Introduction
• Treatment of idiopathic
thrombocytopenic purpura depends on
your signs and symptoms and platelet
count. If no bleeding problems are
present and the platelet count isn't too
low, treatment for idiopathic
thrombocytopenic purpura usually
isn't necessary. The goal of treatment
for both children and adults is to
create a safe platelet count and avoid
bleeding complications. Treatment
 Signs And
Symptoms
• Easy or excessive bruising (purpura)
• Superficial bleeding into your skin that
appears as a rash of pinpoint-sized
reddish-purple spots (petechiae),
usually on your lower legs
• Prolonged bleeding from cuts
• Spontaneous bleeding from your gums
or nose
• Blood in urine or stools
• Unusually heavy menstrual flows
Petechia
e
 Causes
• The exact cause of idiopathic
thrombocytopenic purpura is
unknown. This is why it's referred to
as idiopathic, which means "of
unknown cause." However, scientists
do know that with ITP, the immune
system malfunctions and begins
attacking platelets as if they were
foreign substances.
 Causes
• Antibodies produced by your immune
system attach themselves to the
platelets, marking the platelets for
destruction. The spleen, which helps
your body fight infection, recognizes
the antibodies and removes the
platelets from your system. The result
of this case of mistaken identity is a
lower number of platelets than normal.
 Causes
• Normally, you have anywhere from
150,000 to 450,000 platelets per
microliter of circulating blood. As the
number of your platelets decreases,
your risk of bleeding increases. The
greatest risk is when platelet count
falls very low — below 10,000 platelets
per microliter. At this point, internal
bleeding may occur despite a lack of
any injury, although this is rare.
 Causes
• In children with acute ITP, the disorder
often follows a viral illness, such as the
mumps, a respiratory infection or a flu-
like illness. It may be that such an
infection sets off the immune system,
triggering it to malfunction. But ITP in
adults isn't linked to infections.
 Screening &
Diagnosis

Complete Blood Count (CBC)

 Blood Smear

 Bone Marrow Examination

 CBC
• This common blood test is used to
determine the number of white and
red blood cells and platelets in a
sample of your blood. With ITP, white
and red blood cell counts are usually
normal even though the platelet count
is low. In adults with mild ITP who have
no signs or symptoms, a low platelet
count may be discovered
coincidentally when this blood test is
performed for a different purpose.
 Blood
Smear
• A sample of your blood is
placed on a slide and
observed under a
microscope. This test is
often used to confirm the
number of platelets
observed in a complete
blood count.
 Bone Marrow
Examination
• help identify the cause of a low
platelet count is a bone marrow
examination. Platelets are produced in
your bone marrow. An underlying
problem, such as certain causes of
anemia or leukemia, can affect your
bone marrow's production of platelets
and decrease your platelet count.
• With ITP, however, your bone marrow
is normal because the low platelet
count is caused by immune-related
destruction of platelets, not by
 Treatment
 Corticosteroids


Intravenous Immunoglobulin (IVI

 Surgery

 Immunosuppressant Drugs
 Corticosteroids

• The first line of therapy for ITP is the

use of corticosteroids, usually
prednisone. Prednisone can help raise
your platelet count by decreasing the
activity of your immune system. Once
your platelet count is back to a safe
level, you can gradually discontinue
taking the prednisone under the
direction of your doctor. In general,
this takes about four to six weeks.
 Corticosteroids
• About 70 percent of adults experience a
relapse after discontinuing the
corticosteroids. A new course of
corticosteroids may be pursued; however,
long-term use of these medications has
potentially serious side effects, including
cataracts, high blood sugar, increased risk of
infections, loss of calcium from bones,
menstrual irregularities, suppressed adrenal
gland hormone production, thin skin, obesity,
weakness in shoulders and thighs, easy
bruising and slower wound healing. You and
your doctor will want to weigh the benefits of
the medication against these risks. If you've
taken corticosteroids for longer than three
months, your doctor will likely recommend
 IVIG
• If you need a rapid elevation in
platelet count, such as in the case of
critical bleeding or in preparation for
surgery, you may receive medications
such as immunoglobulin or anti-(Rh) D
immunoglobulin through a needle
placed in your vein (intravenously).
These medications are quick and
effective, but their benefits usually
wear off in a couple of weeks.
 Surgery
• If you have moderate to
severe ITP and the initial
course of prednisone isn't
helping, your doctor may
recommend removal of your
spleen (splenectomy). This
eliminates the main focus of
platelet destruction in your
body and improves your
platelet count. Improvement
is usually seen in a couple of
 Immunosuppressant
Drugs
• Other possible treatments may include
the use of immunosuppressant drugs
such as rituximab (Rituxan) — the
safest and most commonly used of
this group — cyclophosphamide
(Cytoxan), azathioprine (Imuran) or
vinca alkaloids (Vincasar, Velban), but
side effects can be risky.
 Self Care
 Avoid platelet-impairing
medications (such as aspirin and
ibuprofen)
 Limit alcohol (can impair blood
clotting)
 Choose low-impact physical
activities (increase the risk of injury and
bleeding)