Immune Thrombocytopenic Purpura/ITP

-previously idiopathic TP
-Primary and secondary types:
-Primary
-autoimmune, no predisposing factors

secondary:
-virus-mumps, HSV, CMV, HIV---->Ag<----Ab.. destruction.
Acute-in children-2-6 yrs
after virus infection, mumps, herpes zoster, measles,
self-limiting
-mucocutaneous bleeding.

Chronic ITP
mainly 20-40 yrs
-associated with other autominnume disease, SLE, thyroid disease
-months to years
-
Clinical features:
epitaxis, purpura
easy briusing
menorrhagia
in severe thrombocytopenia-ICH
1-5%--spleenomegaly-less work for spleen.

Investigation:                                
FBC-<150*10^9/L
-rbc-normal
BM-increased megakaryocytes
autoimmune Ab-Gp iib ?

Treatment:
children-high dose prednesolone
i.v.IgG
will increased platelet count.
usually not required.

Adult:
>30x10^9-doesnt need urgent but can b monitored platelet count.

<30-1st line treatment-
-oral corticosteroids(1mg/kg)-prednisolone--short course(3 weeks))----66%-short course and gains back the normal count, 33% longer course, remission.
-i.v. IgG, if reoccurs without recovery after prednisolone.--

2nd line treatment:
spleenectomy-decrease destruction of platelet
                     -decreases the rproduction of Ab
                      -2/3 pt gains normal platelet count
                      -lifelong antibiotics
                      -contraindicated in pregnancy and children <6 years.
3rd Line
-after failed splectomy-predisolone, dapsone, azapthioprine, Rh IgG.
-Thrombopoeisis protein-romiplotin(s.c), eltrobopag(oral)

In emergency, platelet transfusion, ICH, steroid infusion like dexamethasone and methyl prednisolone