Question

What is idiopathic thrombocytopenic purpura (ITP)?

2 What are the signs and symptoms of ITP?

3 What laboratory findings confirm a diagnosis of ITP?

4a How is ITP treated?

4b What is human normal immunoglobulin?

4c What other aspects of HNIG administration should be considered?

5 What advice should be given about the use of HNIG?

6 How might ITP affect lifestyle?

Answer 1

1) Deficiency of platelets that occurs when the immune system destroys the body's own platelets

Possibly acute, as in postviral thrombocytopenia, or chronic, as in essential thrombocytopenia or autoimmune thrombocytopenia

Excellent prognosis for acute form; nearly four out of five patients recover without treatment

Good prognosis for chronic form; remissions commonly lasting weeks or years, especially among women

Also called immune thrombocytopenic purpura or ITP

2) Sign and symptoms of ITP :-

Petechiae or ecchymosis

Bleeding into mucous membranes

Gingival bleeding

Bleeding from the GI or urinary tract

Absence of splenomegaly

3) Diagnostic Test Results-Laboratory

Platelet count is less than 75,000/μl.

Bleeding time is prolonged; prothrombin time and partial thromboplastin time are normal.

Complete blood count may reveal lymphocytosis and slight eosinophilia.

Peripheral blood smear reveals normal red blood cells and leukocytes; platelets may appear normal with varying numbers of large platelets.

Hemoglobin level is decreased (if bleeding occurred).

Humoral tests measure platelet-associated IgG (elevated IgG levels in 50% of all patients with ITP).

Diagnostic Test Results-Diagnostic Procedures

Bone marrow studies show abundant megakaryocytes (platelet precursor cells) and a circulating platelet survival time of only several hours to a few days.

4) Treatment-General

Plasmapheresis

Platelet transfusion for significant bleeding

Treatment-Diet

Well-balanced diet

Treatment-Activity

Rest periods between activities

Complete bed rest during active bleeding

Avoidance of contact sports and activities

Treatment-Medications

Oral prednisone; high dose dexamethasone; high dose methylPREDNISolone if prednisone ineffective

I.V. immune globulin as a single dose or for patients with chronic ITP who don't respond to prednisone

Anti-Rho(D) immune globulin or dexamethasone as alternative agents for patients with chronic ITP that is unresponsive to therapy

I.V. methylprednisolone with I.V. immune globulin for emergency treatment

Anti-Rho(D) immune globulin, adults with chronic ITP who are RhD-positive, and those with ITP secondary to human immunodeficiency virus infection

Second-line agents, such as rituximab, eltrombopag, and romiplostim

Thrombopoiesis stimulating agents if all other treatment options have failed

Treatment - surgery

Spleenectomy