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Idiopathic
thrombocytopenic purpura
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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
antiphospholipid 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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