Idiopathic Thrombocytopenic Purpura

Idiopathic thrombocytopenic purpura (ITP), also known as immune thrombocytopenia, primary immune thrombocytopenia, primary immune thrombocytopenic purpura or autoimmune thrombocytopenic purpura. This condition is defined as unusually low levels of platelets (thrombocytopenia) with normal bone marrow and the absence of other causes of thrombocytopenia.

It is a bleeding disorder that can lead to easy or excessive bruising and bleeding. ITP is an autoimmune condition with antibodies detectable against several platelet surface antigens. ITP is diagnosed by a low platelet count in a complete blood count (a common blood test). This allows your doctor to check the amount, sizes and shapes of the cells in your blood. However, since the diagnosis depends on the exclusion of other causes of a low platelet count, additional investigations (such as a bone marrow biopsy) may be necessary in some cases. It can be acute or chronic.

In mild cases, only careful observation may be required but very low counts or significant bleeding may prompt treatment with corticosteroids, intravenous immunoglobulin, anti-D immunoglobulin, or immunosuppressive drugs. Refractory ITP (not responsive to conventional treatment) may require splenectomy, the surgical removal of the spleen. Platelet transfusions may be used in severe bleeding together with a very low count. Sometimes the body may compensate by making abnormally large platelets.

1Signs and symptoms
Symptoms of ITP may include easy or excessive bruising, particularly on the legs, bleeding that seems to be in the skin appearing as a reddish-purple rash (petechiae), bleeding from the gums or nose, blood in the urine or stool and unusually heavy menstrual bleeding are common.
Serious and possibly fatal complications due to extremely low counts of platelets (<5,000 per μl) include bleeding into the brain (which can be fatal), lower gastrointestinal bleeding or other internal bleeding.
Splenectomy (removal of the spleen) may be considered, as platelets which have been bound by antibodies are taken up by macrophages in the spleen (which have Fc receptors). The procedure is potentially risky in ITP cases due to the increased possibility of significant bleeding during surgery. Durable remission following splenectomy is achieved in 60 to 65 percent of ITP cases, less so in older subjects.

As noted in the introduction, the use of splenectomy to treat ITP has diminished since the development of steroid therapy and other pharmaceutical remedies.


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Dr Bruce Kavin is a General Surgeon with particular expertise in Endocrine, Colorectal and Gastrointestinal Surgery and Surgical Oncology.

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