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Idiopathic (Immune)
Thrombocytopenic Purpura
Statistics of ITP
Clinical Manifestations
May be acute or insidious onset
Mucocutaneous Bleeding
*petechiae, purpura, ecchymosis
*epistaxis, gum bleeding
*menorrhagia
*GI bleed, CNS bleed = RARE
Theories:
*antibody cross-reactivity
*H. pylori
*bacterial lipopolysaccharides
??
Auto-antibodies?
Initial Therapy
Prednisone 1 mg/kg/day
*usually response within 2 weeks
Second-Line Therapy
Treatment Side-Effects
Steroids
*bone density loss
*muscle weakness
*GI effects
*weight gain
IVIG/anti-D
*hypersensitivity *headache
*renal failure
*nausea/vomiting
*alloimmune hemolysis
Splenectomy
RISKS
*surgical procedure
*loss of immune function vaccinations
When to do Splenectomy?
Data from George, JN, Woolf, SH, Raskob, GE, et al. Blood 1996; 88:3.
Response Post-Splenectomy
Wrapping it up
ITP is often a chronic disease in adults
Multiple therapies may be needed over
time
Goal = prevention of complications
Therapy needs to be tailored to the
individual patient