Immune thrombocytopenic purpura (ITP) is a clinical syndrome in which a decrease d number of circulating platelets (thrombocytopenia) manifests as a bleeding ten

dency, easy bruising (purpura), or extravasation of blood from capillaries into skin and mucous membranes (petechiae). In persons with immune thrombocytopenic purpura (ITP), platelets are coated with autoantibodies to platelet membrane antigens, resulting in splenic sequestratio n and phagocytosis by mononuclear macrophages. The resulting shortened life span of platelets in the circulation, together with incomplete compensation by incre ased platelet production by bone marrow megakaryocytes, results in a decreased p latelet count. Peripheral blood smear from a patient with immune Peripheral blood smear from a patient with immune thrombocytopenic purpura (ITP) illustrates a decreased numbe r of platelets, a normal-appearing neutrophil, and erythrocytes. ITP is diagnose d by excluding other diseases; therefore, the absence of other findings from the peripheral smear is at least as important as the findings are observed. This sm ear demonstrates the absence of immature leukocytes (as in leukemia) and fragmen ted erythrocytes (as in thrombotic thrombocytopenic purpura) and no clumps of pl atelets (as in pseudothrombocytopenia). To establish a diagnosis of immune thrombocytopenic purpura (ITP), exclude other causes of thrombocytopenia, such as leukemia, myelophthisic marrow infiltration , myelodysplasia, aplastic anemia, or adverse drug reactions. Pseudothrombocytop enia due to platelet clumping is also a diagnostic consideration. No single laboratory result or clinical finding establishes a diagnosis of immun e thrombocytopenic purpura (ITP); it is a diagnosis of exclusion. For excellent patient education resources, visit eMedicine's Blood and Lymphatic System Center and Cuts, Scrapes, Bruises, and Blisters Center. Also, see eMedic ine's patient education article Bruises.