Gingival bleeding and epistaxis are common.

The latter usually responds for a time to

conservative measures, such as nasal packing or tamponade, often to recur intermittently.
Epistaxis may originate from lesions resembling petechiae in the nasal mucosa. Such
lesions also may be found in the mucous membranes of the throat and mouth, sometimes in
the absence of cutaneous hemorrhage. In many patients, discrete bleeding points cannot be
identified. The genitourinary tract is a frequent site of bleeding. Menorrhagia may be the only
symptom of ITP and may appear for the first time at puberty. Hematuria also is a common
symptom, the blood coming from the kidneys, the bladder, or the urethra, although bleeding
into the kidney parenchyma is rare. Gastrointestinal bleeding is usually manifested by
melena or, less often, by hematemesis.

Central Nervous System

Intracranial hemorrhage is the most serious complication of ITP. Fortunately, it is rare,
affecting 1% to 2% or less of patients with severe thrombocytopenia. The hemorrhages
usually are subarachnoid, often are multiple, and vary in size from petechiae to large
extravasations of blood. Numerous small hemorrhages often are seen in the retina;
subconjunctival hemorrhage may also occur.

Bleeding after Trauma

Excessive bleeding often follows tooth extractions, tonsillectomy, or other operations or
injuries and may first suggest the diagnosis of ITP. In contrast to the hereditary coagulation
disorders, such traumatic bleeding is seldom voluminous or rapid. Slow persistent oozing
may occur after trivial cuts, razor nicks, and scratches. Delayed bleeding and spontaneous
hemarthrosis, which are characteristic of the hereditary coagulation disorders, are extremely
rare in ITP.