Immune Thrombocytopenic Purpura (ITP)

Immune thrombocytopenia (ITP) in adults

Immune (or idiopathic) thrombocytopenic purpura (ITP) is an immune-mediated reduction in the platelet count. Antibodies are directed against the glycoprotein IIb/IIIa or Ib-V-IX complex.

Children with ITP usually have an acute thrombocytopenia that may follow infection or vaccination. In contrast, adults tend to have a more chronic condition.

ITP in adults

Epidemiology

• more common in older females

Presentation

• may be detected incidentally following routine bloods
• symptomatic patients may present with
  • petechiae, purpura
  • bleeding (e.g. epistaxis)
  • catastrophic bleeding (e.g. intracranial) is not a common presentation

Investigations

• full blood count: isolated thrombocytopenia
• blood film
• a bone marrow examination is no longer used routinely
• antiplatelet antibody testing has poor sensitivity and doesn't affect clinical management so is not commonly done

Management

• first-line treatment for ITP is oral prednisolone
• pooled normal human immunoglobulin (IVIG) may also be used
  • it raises the platelet count quicker than steroids, therefore may be used if active bleeding or an urgent invasive procedure is required
• splenectomy is now less commonly used