IDIOPATIK TROMBOSITOPENI PURPURA PDF

Idiopathic thrombocytopenic purpura ITP is defined as a hematologic disorder, characterized by isolated thrombocytopenia without a clinically apparent cause. The major causes of accelerated platelet consumption include immune thrombocytopenia, decreased bone marrow production, and increased splenic sequestration. The clinical presentation may be acute with severe bleeding, or insidious with slow development with mild or no symptoms. Treatment should be restricted to those patients with moderate or severe thrombocytopenia who are bleeding or at risk of bleeding. We present a case report on ITP with clinical presentation, diagnosis and management. Idiopathic thrombocytopenic purpura ITP is the condition of having a low platelet count thrombocytopenia of no known cause idiopathic.

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ITP is reported in approximately 2 per , adults. ITP is more common in females of childbearing age and in pregnancy. In adults, the course is more chronic although spontaneous remission can also occur within months of initial diagnosis. A thorough and timely workup of thrombocytopenia is imperative to rule out other differentials of ITP as it is considered a diagnosis of exclusion.

Primary care physicians encounter patients who exhibit signs of thrombocytopenia such as petechiae or purpura on a regular basis. A high index of clinical suspicion is required to accurately diagnose ITP and commence the appropriate treatment including glucocorticoids to increase the chances of a favorable prognosis as described by the authors.

ITP is more common in females of childbearing age and in pregnancy [ 2 ]. Prognosis is good in children, with most achieving remission [ 1 ]. In adults, the course is more chronic although spontaneous remission can also occur. This would usually happen within months of initial diagnosis. Mortality is higher in older patients and those who do not respond to initial therapy. Although the pathogenesis is still unclear, ITP is believed to result from the development of an immunoglobulin G autoantibody targeting structural platelet membrane glycoproteins IIb-IIIa [ 3 ].

This renders platelets susceptible to phagocytosis by splenic macrophages and Kupffer cells in the liver. Thus, other mechanisms including impaired production of the glycoprotein hormone thrombopoeitin, a stimulant for platelet production as well as triggers such as childhood exposure to viruses, helicobacter pylori infection and pregnancy are thought to contribute to ITP [ 5 , 6 ]. Mucocutaneous bleeding occurs as a consequence of a primary hemostasis defect versus a secondary hemostasis defect and deeper organ bleeding which occur more commonly in other coagulopathies.

Clinical manifestations include petechiae, purpura and ecchymosis that occur primarily in the upper and lower extremities Figure 1. Petechiae can also occur in mucosal membranes including the hard palate, nasal septum or gums leading to nose and gum bleeds. Menorrhagia can be seen in females. Fatal complications including intracerebral hemorrhage or overt gastrointestinal bleeding are less common. The differential diagnosis includes thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, disseminated intravascular coagulation, paroxysmal nocturnal hemoglobinuria, myelodysplastic syndrome, lymphoproliferative disorders, infection HIV, Hepatitis C , and drug-induced thrombocytopenia alcohol, heparin, sulfonamides.

In patients with ITP, isolated thrombocytopenia with normal hemoglobin and leukocyte count are evident, unless bleeding has occurred. ITP is a diagnosis of exclusion, therefore it is imperative to rule out other causes of isolated thrombocytopenia. Typically, coagulation studies, HIV and Hepatitis C testing and a peripheral blood smear are essential investigations [ 8 ].

Peripheral blood smear can show enlarged platelets without schistocytes. Bone marrow aspiration is rarely required and reserved for patients whom the diagnosis is uncertain; who are not responding to standard therapies or if the blood smear shows abnormalities aside from thrombocytopenia [ 8 ].

The measurement of platelet-associated antibodies is not helpful as this testing lacks both sensitivity and specificity. When significant bleeding occurs treatment is initiated. Splenectomy can achieve complete remission in two thirds of patients however can increase the risk of thrombosis and infection with encapsulated bacteria. As such, vaccination against Streptococcus pneumonia, Haemophilus influenza type B and Neisseria meningitides is indicated [ 8 ].

In life threatening bleeds, platelet transfusion can also be initiated which otherwise would normally be ineffective due to rapid consumption. Clinical symptoms and signs to suggest thrombocytopenia can be commonly encountered in primary care offices. Signs of thrombocytopenia such as petechia and purpura are a common presentation to primary care.

Thrombocytopenia should be reflexive in a differential and if established, it is imperative to rule out other systemic illnesses and medications associated with thrombocytopenia as listed above to avoid devastating complications. National Center for Biotechnology Information , U.

Published online Feb Author information Article notes Copyright and License information Disclaimer. Received Nov 5; Accepted Dec This article has been cited by other articles in PMC. Figure 1. Pathophysiology Although the pathogenesis is still unclear, ITP is believed to result from the development of an immunoglobulin G autoantibody targeting structural platelet membrane glycoproteins IIb-IIIa [ 3 ].

Diagnosis 3. Differential diagnosis The differential diagnosis includes thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, disseminated intravascular coagulation, paroxysmal nocturnal hemoglobinuria, myelodysplastic syndrome, lymphoproliferative disorders, infection HIV, Hepatitis C , and drug-induced thrombocytopenia alcohol, heparin, sulfonamides.

Investigations In patients with ITP, isolated thrombocytopenia with normal hemoglobin and leukocyte count are evident, unless bleeding has occurred. Open in a separate window. Conclusion Clinical symptoms and signs to suggest thrombocytopenia can be commonly encountered in primary care offices. Disclosure statement No potential conflict of interest was reported by the authors. References [1] Michel M. Immune thrombocytopenic purpura: epidemiology and implications for patients.

Eur J Haematol. Current management of primary immune thrombocytopenia. Adv Ther. ITP: a historical perspective. Br J Haematol. Autoantibodies to thrombopoietin and the thrombopoietin receptor in patients with immune thrombocytopenia. Thrombopoietin-receptor agonists for primary immune thrombocytopenia.

N Engl J Med. Helicobacter pylori eradication in patients with immune thrombocytopenic purpura: a review and the role of biogeography. Current and evolving treatment strategies in adult immune thrombocytopenia. Oncol Res Treat. Support Center Support Center. External link. Please review our privacy policy.

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Idiopathic Thrombocytopenic Purpura (ITP)

ITP is reported in approximately 2 per , adults. ITP is more common in females of childbearing age and in pregnancy. In adults, the course is more chronic although spontaneous remission can also occur within months of initial diagnosis. A thorough and timely workup of thrombocytopenia is imperative to rule out other differentials of ITP as it is considered a diagnosis of exclusion. Primary care physicians encounter patients who exhibit signs of thrombocytopenia such as petechiae or purpura on a regular basis. A high index of clinical suspicion is required to accurately diagnose ITP and commence the appropriate treatment including glucocorticoids to increase the chances of a favorable prognosis as described by the authors. ITP is more common in females of childbearing age and in pregnancy [ 2 ].

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Idiopathic thrombocytopenic purpura

Immune thrombocytopenia purpura ITP , also known as idiopathic thrombocytopenic purpura , is a type of thrombocytopenic purpura defined as an isolated low platelet count with a normal bone marrow in the absence of other causes of low platelets. Two distinct clinical syndromes manifest as an acute condition in children and a chronic condition in adults. The acute form often follows an infection and spontaneously resolves within two months. Chronic immune thrombocytopenia persists longer than six months with a specific cause being unknown. ITP is an autoimmune disease with antibodies detectable against several platelet surface structures. ITP is diagnosed by identifying a low platelet count on a complete blood count a common blood test.

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Immune thrombocytopenic purpura

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Immune thrombocytopenia ITP is a disorder that can lead to easy or excessive bruising and bleeding. The bleeding results from unusually low levels of platelets — the cells that help blood clot. Formerly known as idiopathic thrombocytopenic purpura, ITP can cause purple bruises, as well as tiny reddish-purple dots that look like a rash. Children may develop ITP after a viral infection and usually recover fully without treatment. In adults, the disorder is often long term. If you don't have signs of bleeding and your platelet count isn't too low, you may not need any treatment. If your symptoms are more severe, treatment may include medications to boost your platelet count or surgery to remove your spleen.

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