Immune thrombocytopenic purpura

Essential features:

• easy bruising

• epistaxis and menorrhagia common

• no systemic illness

• splenomegaly rare

• isolated thrombocytopenia

• other blood cells normal

• otherwise normal physical examination

• normal bone marrow with normal or increased megakaryocytes The two distinct types caused by immune destruction of platelets are:

• acute ITP: usually in children, often post-viral

• chronic ITP: autoimmune disorder, usually in adult women; all cases should be referred to a specialist unit

Chronic ITP rarely undergoes spontaneous remission and may require treatment with prednisolone. Some require splenectomy but this operation is avoided where possible, especially in young children, because of the subsequent risk of severe infection, particularly with Streptococcus pneumoniae. 4

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