Patients are usually not sick, usually normal. Compared with HSP where children are usually sick.
Also called idiopathic thrombocytopenic purpura.
“idiopathic thrombocytopenic purpura (ITP) is an acquired autoimmune disorder that results in platelet destruction. It often follows a viral illness and is more common in children than adults. It is characterized by thrombocytopenia in the absence of other bone marrow pathology. Signs and symptoms include petechiae, purpura, and gingival bleeding. Management depends on degree of thrombocytopenia and presence of bleeding, and should be performed in consultation with a hematologist.
In general, patients with platelet count of 10,000-20,000 µL and mucosal bleeding or those with platelet counts < 10,000 µL and no bleeding are treated with corticosteroids or intravenous immunoglobulin (IVIG) or both. Asymptomatic patients with platelets > 20,000µL can be observed, as the condition is often self-limited.
[The American Society of Hematology recommends that NO pharmacologic intervention or “watchful waiting” be done for most children with no bleeding or mild bleeding (only bruising and petechiae), regardless of platelet count. Restricting physical activities with risk of trauma is recommended for children with moderate or severe thrombocytopenia.]
Question: What is the mechanism of thrombocytopenia in idiopathic thrombocytopenic purpura? Answer: Autoantibodies directed against platelets lead to platelet destruction.
Children 2-6 years old: Most often acute. Often follows a viral infection
Adults 20-50 years old: Most often chronic.
Clinical signs: Petechiae, gingival bleeding, epistaxis, menorrhagia, GI bleeding, intracranial hemorrhage.”
Treatment:
Supportive in children
Platelets (only for severe bleeding or very low platelet count)
Corticosteroids
IVIG or anti-D immunoglobulin
Splenectomy
“Immune (idiopathic) thrombocytopenic purpura is an acquired immune-mediated disorder defined as isolated thrombocytopenia not found to have another cause. Treatment is usually restricted to severe thrombocytopenic cases (platelet count <50,000/mm3) unless there is evidence of acute bleeding. Corticosteroids are considered the first-line therapy (SOR C). Intravenous immunoglobulin and rituximab have also been used as first-line agents. Second-line therapies include thrombopoietin-receptor agonists and splenectomy. Further evaluation, including a bone marrow biopsy, to rule out myelodysplastic syndrome and lymphoproliferative disorders is indicated in patients over the age of 60 (SOR C). Platelet transfusion is not indicated in the absence of hemorrhage or a need for surgery.” ABFM critique