Idiopathic Thrombocytopenic Purpura (ITP). By Sundip Grewal. (Sunny)

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• Idiopathic Thrombocytopenic Purpura (ITP).By
  Sundip Grewal.(Sunny)

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Contents.

• What is ITP?
• Epidemiology.
• Pathogenesis.
• The Diagnoses.
• Case study.
• Treatment.
• References.

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What is ITP?

• Idiopathic means unknown cause.
• Thrombocytopenia is the medical term for a low
  platelet (thrombocyte) count.
• Purpura refers to the development of bruises.

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Epidemiology.

• Acute ITP lasts lt 6 months. It mainly occurs in
  children. It is the most common type of ITP. It
  often occurs after an infection from a virus.
• Chronic ITP lasts gt 6 months. It occurs mainly in
  adults. Women are 2-3 times more likely to be
  affected by Chronic ITP.
• Reference range of a normal platelet count is
  (150450 x 109/L)

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Pathogenesis of ITP.

• In 60 of patients with ITP, cause is not
  idiopathic but autoimmune.
• -Abs of the IgG type binds to 1 of the platelet
  membrane glycoproteins IIb IIIa or Ib-IX.
• This makes the platelets susceptible to
  oponisation and phagocytosis by splenic
  macrophages.

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How is it Diagnosed/monitored?

• Medical history.
• Physical examination.
• A full blood count is carried out.
  
• 3 different types of sample tubes consisting of
  different anti-coagulants are sent to the
  laboratory.
• Microscope slides are prepared and analysed under
  a microscope.
• Bone marrow slides may also be prepared to
  exclude any other possible causes such as
  leukaemia.

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Case Study

• 12 year old male.
• Presented in emergency room with recent onset of
  easy bruising and bleeding gums.
• Previously in excellent health. Father stated he
  was "never sick before in his entire life."
• No history of recent viral infection, and no
  family history of bleeding disorders.
• EDTA and Citrate sample was sent to the lab for
  analysis.

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Haematology Results.

• RBC 4.52 x 1012/L
  (4.0-5.2)
• HGB 13.4 g/dL
  (11.5-15.5)
• MCV 82.3 fL
  (77-95)
• MCH 29.6 pg
  (25.0-32.0)
• MCHC 35.9 g/dL
  (31.0-36.0)
• WBC 5.3 x 109/L
  (4.5-14.5)
• N 44
• L 39
• M 14
• E 1
• B 2
• PLT lt5 x 109/L (150450 x 109/L)

Coagulation INR 0.91 (RI 0.85-1.15) PTT 24.8
sec (RI 23-34)TT 15.8 sec (RI 13-18)
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One giant platelet seen under the microscope.
Below shows a normal platelet count.
Bone marrow slide was requested for further
investigations.
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• What is the most likely diagnoses?

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• Diagnosis
• Immune thrombocytopenic purpura (ITP)

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Treatment.

• A platelet count of lt20,000 is an indication of
  treatment. 20,000- 50,000 patients are monitored.
  gt50,000 treatment is not necessary.
• Steroids i.e prednisone.
• Immunoglobulins (IgG).
• Anti-D administration.
• Thrombopoietin Rececptor agonists. As of 2011 2
  such products are available. Romiplostim
  Eltrombopag.
• Surgery.
• Antibiotics used for the treatment of
  Helicobacter.pylori.
• Platelet transfusion.

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References.

• Essential Haematology A.V.Hoffbrand.
• http//www.health-writings.com/img/fg/henoch-schon
  lein-purpura-long-term/afp20091001p697-f3.jpg
• http//www.netdoctor.co.uk/diseases/facts/itp.htm
• http//lowplateletconcerns.com/images/platelets.jp
  g
• http//www.winrho.ca/healthcare/images/3.gif
• Imbach P, Kuhne T, Signer E. Historical aspects
  and present knowledge of idiopathic
  thrombocytopenic purpura. Br J Haematol
  2002119894-900.

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• Thank you.
• Any questions?