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Idiopathic Thrombocytopenic Purpura
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ITP
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- This is an autoimmune disorder (the body
mistakenly attacks itself) in which IgG antibodies bind to
the platelets (platelets are elements in the blood involved
in clotting). This causes the platelets to be destroyed
in the spleen and, as a result, the blood does not clot
properly. Acute ITP often is seen in childhood, and is secondary
to infections. Chronic ITP is seen in adults and lasts
for months or years. Risks include infections (including
HIV), hypersplenism, preeclampsia, presence of anti
phospholoipid antibodies, and
age.
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- Bleeding under the skin
- Bleeding in the gums
- Nose bleeds
- Increased menstrual bleeding
- Raised red lesions of the skin
- Diffuse small red lesions of the
skin
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- Childhood viral illnesses
- Adult -- unknown cause, usually
occurs at 20-50 years of
age
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- Skin findings as above
- Enlarged spleen
- Low platelets -- may even be below
100,000/milliliter
- Platelets that are present are
slightly enlarged (megathrombocytes)
- Hemolytic anemia is present in 10%
(but no red cell fragmentation)
- PT and PTT (measure clotting
factors of blood) tests are often normal
- Bone Marrow Biopsy is normal
- Quantitative anti-platelet IgG
antibody measurements may aid in diagnosis (very
sensitive, but not
specific)
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- Avoid aspirin and anti-inflammatory
medications (e.g., ibuprofen)
- Prednisone -- A high dose will
usually raise platelets quickly, while a low dose is usually
needed for maintenance.
- Splenectomy (surgical removal of the
spleen) will cure the disease.
- High dose intravenous immunoglobulin
for severe disease to raise the platelets quickly. It is
very expensive so it is usually only used for 1- 5 days (the
benefit lasts 1-2 weeks).
- Danazol helps some persons who fail
both prednisone and splenectomy.
- Platelet transfusions are used for
life-threatening bleeding only because these platelets are
just as likely to be destroyed as the body's own
platelets.
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