In immune thrombocytopenia (ITP) the immune system makes antibodies that destroy platelets and slow their production, so the platelet count falls while the rest of the blood count stays normal. Children often get it after a viral illness and recover on their own, while adults more often have a chronic course.
Key symptoms
- Easy bruising and tiny red-purple spots on the skin (petechiae)
- Bleeding gums, nosebleeds or blood blisters in the mouth
- Heavy menstrual periods
- Often no symptoms; low platelets found on a routine blood count
- Recent viral infection, especially in children
What you find on exam
- Petechiae and purpura, often on the legs and in the mouth
- Look for active bleeding from the nose, gums or gut
- No enlarged spleen or lymph nodes; if present, think of another cause
- Patient otherwise looks well, without fever or weight loss
Tests
- Blood count: isolated low platelets with normal hemoglobin and white cells
- Peripheral smear to rule out platelet clumping and other blood diseases
- HIV and hepatitis C testing in adults; H. pylori testing in some
- Bone marrow biopsy only if atypical features or poor response to treatment
Treatment basics
- Observation if platelets are above about 30,000 and there is no bleeding
- Corticosteroids such as prednisone or dexamethasone as first-line therapy
- IVIG for a fast rise when bleeding or before a procedure
- Second line: thrombopoietin receptor agonists (eltrombopag, romiplostim), rituximab or splenectomy
- Platelet transfusion only for life-threatening bleeding; avoid aspirin and NSAIDs
Red flags
- Headache, confusion or neurologic signs: possible brain bleed
- Heavy gut, urinary or menstrual bleeding
- Fever, anemia, kidney injury or abnormal smear: think of TTP or leukemia
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.