Idiopathic thrombocytopenic purpura (ITP) is a bleeding disorder caused by a low platelet count due to the immune system destroying platelets. It can be acute (lasting less than 6 months, usually in children due to viral infections) or chronic (lasting 6 months or longer, more common in adults). While the cause is unknown, risk factors include autoimmune disorders, viral infections, medications, chemicals, and pregnancy. Symptoms include easy bruising, small red dots under the skin, and excessive bleeding. Diagnosis involves blood tests and exams. Treatment focuses on maintaining a safe platelet count through corticosteroids, IVIG, thrombopoietin receptor agonists, immunosuppressants

1. RATHEESH R.L
IDIOPATHIC
THROMBOCYTOPENIC
PURPURA

2. DEFINITION
 Idiopathic thrombocytopenic
purpura (ITP) is a bleeding disorder in which
the immune system destroys platelets, which
are necessary for normal blood clotting.

3.  “Idiopathic” means the cause of the condition
is not known.
 “thrombocytopenic” means there is a lower
than normal number of platelets in the blood
 “purpura” refers to purple bruises caused by
bleeding under the skin

4. TYPES
 There are two types of ITP
 Acute ITP
 Chronic ITP

5. ACUTE ITP
 Acute ITP is the most common form of the
disorder. It usually lasts less than six months
and mainly occurs in children.
 Mainly caused b infections with viruses.

6. CHRONIC ITP
 Chronic ITP lasts six months or longer. It’s
most commonly seen in adults, although
teenagers and younger children can be
affected.
 It does not need treatment if the platelet level
does not pose a risk of bleeding

7. ETIOLOGY AND RISK FACTORS
 The word “idiopathic” means “of unknown
cause.” This means the exact cause of ITP
hasn’t been identified.

8.  Other risk factors are
 Autoimmune disorders like SLE
 Among children Viral infections such as mumps
or flu
 Among adults viral infections such as rubella and
chicken pox
 Use of drugs like sulfa drugs
 Exposure to insecticides and chemicals
 pregnancy

9. CLINICAL MANIFESTATIONS
Some people with ITP have no symptoms.
 The most common symptoms of ITP are:
 bruising easily
 pinpoint-sized petechiae, often on the lower
legs
 spontaneous nose bleeds
 bleeding from the gums (for example, during
dental work)

10.  blood in the urine
 blood in the stool
 abnormally heavy menstruation
 prolonged bleeding from cuts
 profuse bleeding during surgery

11. DIAGNOSIS
 History collection and physical examination
In the physical examination
should evaluate for the signs of bleeding under
the skin, and will ask about the previous illness
and the types of medications and supplements
that recently taken

12.  Complete blood count
The RBC, WBC and platelet count
should be evaluated.
RBC & WBC will be normal but the
level of platelet will be decreased.

13.  Blood smear test
a sample of blood is placed on a
slide and observed under microscope . This
test is often used to confirm the number of
platelets.

14.  Bone marrow examination
it is to identify, whether the
decreased number of platelet is because of the
abnormalities in the bone marrow.

15. MANAGEMENT
 The goal of treating ITP is to ensure a safe
platelet count and prevent bleeding
complications while minimizing treatment
side effects.

16.  Among children ITP usually cures without
any treatment
 80% of children with ITP recover completely
within 6 months

17.  Adults with mild cases of ITP requires
monitoring and regular platelet checking.
 But if the symptoms are worsening,
treatment is necessary.

18.  Corticosteroids
The doctor may prescribe a
corticosteroid, such as prednisolone, which can
increase the platelet count by decreasing the
activity of the immune system.

19.  Intravenous Immune Globulin (IVIG)
If bleeding has reached a critical
level or the patient is going to have surgery
and need to increase the platelet count quickly,
so the patient may be given intravenous
immune globulin (IVIG).

20.  Thrombopoietin Receptor Agonists
Thrombopoietin receptor agonists,
including romiplostim and eltrombopag.
it help to prevent bruising and
bleeding by causing the bone marrow to
produce more platelets.

21.  Immuno suppressants
Immuno suppressants inhibit the
activity of the immune system. They include:
 Rituximab (Rituxan)
 Cyclophosphamide (Cytoxan)
 Azathioprine (Imuran, Azasan)

22.  Platelet transfusions:
The platelet transfusion is required
when the level of platelets is decreasing.

23.  Antibiotics
Some people with ITP are
also infected with Helicobacter pylori, which is the
same bacteria that causes most peptic ulcers.
Antibiotic therapy to eliminate H. pylori has helped
increase platelet counts in some people.

24.  Surgery
If the patient have severe ITP
and medication doesn’t improve the symptoms
or platelet count, the doctor may advise
surgery to remove the spleen.
This is called a spleenectomy.

25. LIFESTYLE CHANGES
 Avoid certain over-the-counter drugs that can
affect platelet function, including aspirin,
ibuprofen (Advil, Motrin), and the blood-thinning
medication warfarin (Coumadin).
 Limit your intake of alcohol because consuming
too much alcohol can adversely affect blood
clotting.

26.  Choose low-impact activities instead of
competitive sports or other high-impact
activities to decrease your risk of injury and
bleeding.

27. NURSING MANAGEMENT
 Protect the patient from trauma, keep the
side rails up.
 Instruct avoid brushes and blades promote
the use of electric razors and soft tooth brush
 Avoid invasive procedures such as
venipuncture and urinary catheterization

28.  Monitor platelet count daily and watch for
bleeding
 Warn the patient to avoid the use of aspirin
 Advice the patient to avoid straining during
defecation and coughing
 Administer stool softners to prevent constipation