Immune thrombocytopenic purpura (ITP) is a clinical syndrome in which a decreased number of circulating platelets (thrombocytopenia) manifests as a bleeding tendency, easy bruising (purpura), or extravasation of blood from capillaries into the skin and mucous membranes (petechiae).

1. Immune
thrombocytopenia
BY: ANKIT KHANDELWAL

2. About ITP…..
 ITP is an autoimmune disorder.
 ITP may occur when the immune system mistakenly
attacks platelets.
 It is mainly seen in children where it is usually acute,
and also occurs in adults, where it is usually chronic in
nature.
 A normal platelet count is b/w 150,000-
400,000/microliter of blood. If someone has a platelet
count lower than 100,000/microliter of blood with no
other reason for low platelets, that person is considered
to have ITP.

4. Causes
 In some people thrombocytopenia is caused when, the immune system
mistakenly attacking and destroying platelets. If the cause of this
immune reaction is unknown, the condition is called idiopathic
thrombocytopenic purpura.
 Inadequate platelets productions

5. Pathophysiology

6.  Antibody directed against the platelets
surface develops with resultant sudden onset
of thrombocytopenia
 After binding of the antibody to the platelets
surface, circulating antibody – coated
platelets are recognized by the Fc receptor on
splenic macrophages, ingested and destroyed.

7. Sign &
Symptoms
Excessive bruising (purpura)
Superficial bleeding into the skin that appears as a rash of
pinpoint-sized reddish-purple spots , usually on the lower legs
Bleeding from the gums or nose
Blood in urine or stools
Unusually heavy menstrual flow

8. Risk factors
ITP can occur in anyone at almost any
age, but these factors increase the risk:
1. sex : Male are two to three times
more likely to develop ITP than
women
2. viral infection : Many children
with ITP develop the disorder after
a viral illness, such as mumps,
measles or a respiratory infection.

9. S/no TEST CHECK PRICE
1. CBC Count of blood cells & platelets 350
2. Bone marrow
exam
identify the cause of a low platelet
count,
950
3. Blood
coagulation
test
To check bleeding time _
Diagnosis test

10. PREVELENCE
prevalence rate of ITP IN INDIA : (2017)
 Upto 9.5/100000
 Population: 125,796(approx)
prevalence rate of ITP in US (2009)
 Upto 7.4/ 100,000 children

11. Treatment..
First line treatment :
1. Corticosteroids
2. IVIG
3. Anti-D immunoglobulin
Second line treatment :
1. Splenectomy
2. Rituximab

12. Corticosteroids
Act through several mechanism’s:
 Inhibition of phagocytosis
 Inhibition of Antibody production
 Improved platelets production
Side effect:
 For short period : No side effect
 For long period: Stopping the WBC working properly increase the chance of
infection
 Prednisolone oral is mainly used for less seviour cases in children.

13. IVIG
 Act through :
Blocked the Fc receptor
Increase in the platelets counts
 Advantage: IVIG work quickly and safely as compare to corticosteroids .
 Disadvantages: Effect doesn't last long (Few week)

14. Anti D
 It can only be used to treat Rh(D)+ve patients
Advantages:
 Less infusions volume:
Anti (D)IV: 8 – 10ml
IVIG : 500 – 600 ml
 Price : Anti –D iv Price is very low as compare to IVIG

15. Combination therapy
Combination of IVIG and Prednisolone:
 Combination of IVIG and oral prednisolone/methylprednisolone has
proven to be more effective and safer than IV methylprednisolone or
oral prednisolone in adults with severe ITP.
 It is used in patients with severe ITP to rapidly increase platelet
counts.

16. Global market position
 The global market for ITP therapeutics was valued at USD 381.99
million in 2013 and is expected to grow at a CAGR of 5.9% .
 Global idiopathic thrombocytopenic purpura (ITP) therapeutics
market is expected to reach USD 566.4 million by 2020.
 The global market for corticosteroid is valued at over USD 125.0
million in 2013. Corticosteroids are regularly used in idiopathic
thrombocytopenic purpura treatment

17. THANK YOU