1. IMMUNE
THROMBOCYTOPENIC
PURPURA

2. Platelet Count And Consideration
• 1,50,000-4,50,000 – Normal
• Less than 1,50,000 platelets/μL is thrombocytopenia
• 20,000 to 50,000 platelets/μL can aggravate posttraumatic bleeding
• less than 20,000 platelets/μL may be associated with spontaneous
(nontraumatic) bleeding

4. Approach to thrombocytopenia
 History
-Is the patient bleeding?
-Do the sites of bleeding suggest a platelet defect?
- Duration - Is thrombocytopenia acute or chronic ?
- Is there a history of medications, alcohol use, or recent transfusion (postn transfusion
purpura) ?
- Are there any symptoms of a secondary illness?
-(neoplasm, infection, autoimmune disease)
-Is there a family history of thrmobocytopenia ?
-Heparin exposure - recent or within past three months (HIT)?
- Are there any risk factors for HIV infection?
-History of liver disease?

6. Immune Thrombocytopenic Purpura
 Immune (idiopathic) thrombocytopenic purpura (ITP) is thrombocytopenia
(platelets <1,50,000/mm³) due to an auto- immune disorder which occurs due
to presence of autoantibodies directed against platelet membrane
glycoproteins mainly GPIIb/Illa and GPIB/IX.
 Since every patient may not have purpura, the term ITP is redefined as
immune thrombocytopenia

7. Classification
1. Primary
2. Secondary
 Post-Infectious: HIV, HCV, CMV, H.Pylori
 - Antiphospholipid syndrome
 SLE
 Autoimmune thrombocytopenia (e.g. Evan's syndrome)
 Lymphoproliferative Disorders: CLL, NHL, HD
 Common Variable Immune Deficiency Drog Induced ITP

8. Types Of ITP
1. Acute (<6months)
 Most frequent in children (2-6 years) ,affects both sexes equally
 Commonly follows an antecedent upper respiratory viral infection
 Usually a self-limiting disease .Abrupt onset of haemorrhage into skin and
mucous membranes-e.g. purpura, petechiae, ecchymoses, epistaxis, bleeding
from oral cavity, gastrointestinal and genitourinary tracts
 Intracranial haemorrhage occurs rarely.

9. Signs and Symptoms
 Scattered petechiae
 Bleeding signs and symptoms
 Mucosal bleeding
 GI Bleeding
 Intracranial hemorrhage (rare)
 Hematuria
 Thrombocytopenia
 Purpura

10. 2. Chronic(>6 months)
 Most frequent in adults (20-40 years)
 Females affected more than males (M:F ratio, 1:3)
 Usually no preceding history of viral infection
 Usually a chronic disease characterised by remissions and relapses Insidious onset of
haemorrhage into skin and mucous membranes-e.g. purpura, petechiae, ecchymoses, epistaxis
and menorrhagia.ti Purpurae are more common in the distal parts of limbs.

11.  Bleeding signs and symptoms
 Mucocutaneous bleeding
 Recurrent epistaxis
 Hematuria
 Purpura
 Thrombocytopenia
 Excessive bleeding with minor injuries
 Spontaneous bleeding from the mouth and nose
 Unexplainable or spontaneous bruising
 Excessive internal bleeding
 Disturbed sleep cycle/ Insomnia
 Irregular appetite
 Depression

14. Diagnostic Test
 Coagulation test
 Bleeding time: prolonged
 Retraction time
 CBC: low number of platelets
 Platelet associated Antibody may be detected
 Bone Marrow Examination: shows megakaryocytic hyperplasia

15. Peripheral smear showing megathrombocytes

16. Bone marrow reveals a modestly increased
number of megakaryocytes.Some are apparently
immature, with large, nonlobulated,single nuclei.