Immune Thrombocytopenic Purpura

A common cause for thrombocytopenia in young children- 2 – 6years age is immune IgG-mediated destruction of platelets.

Frequently, there is a preceding viral infection/ other immune trigger.

Generally ‘acute’ ITP resolves over weeks but sometimes becomes chronic if thrombocytopenia persists over 6 months.

History:

– Preceding symptoms

– Pattern of bleeding: petechiae, purpura, bruises, nose bleeds or melena

– Distribution of purpura / bruises

– Any fevers, weight loss, night sweats or bone pain

– Any chronic illness?

Examination:

– Distribution of petechiae/ purpura

– Any mucosal bleeds?

– Swollen joints?

– Lymphadenopathy?

– Hepatomegaly or splenomegaly?

Investigations:

Immediate:

– FBC & Coagulation

– Blood film for manual platelet count

– Platelets are commonly <20 x 109/L

 

Discuss with Haematologist for 

  bone marrow aspiration if also:

– Severe anaemia / neutropenia

– Hepatospleenomegaly

– Lymphadenopathy

– Limp, abdo pain, tiredness

Management:

– Educate about ITP

– Explain to avoid contact sports & avoid NSAIDs

– Monitor platelet count  every 2 – 4 weeks until recovery (or sooner if significant bleeding)

– Discharge from follow up after platelets >100 x 109/L

– Remember small risk of relapse

 

If small bleeding, give Tranexamic acid

If major bleeding, give 

– Platelet transfusion

– Methylprednisolone

– IV Immunoglobulin

 

Chronic ITP is persisting >6m

Higher chances if older child >10y and in females

Sometimes splenectomy needed