ITP Idiopathic thrombocytopenic purpura This is an autoimmune disorder (the body mistakenly attacks itself) in which IgG antibodies bind to the platelets (platelets are elements in the blood involved in clotting). This causes the platelets to be destroyed in the spleen and, as a result, the blood does not clot properly. Acute ITP often is seen in childhood, and is secondary to infections. Chronic ITP is seen in adults and lasts for months or years. Risks include infections (including HIV), hypersplenism, preeclampsia, presence of antiphospholipid antibodies, and age. Bleeding under the skin Bleeding in the gums Nose bleeds Increased menstrual bleeding Raised red lesions of the skin Diffuse small red lesions of the skin Childhood viral illnesses Adult -- unknown cause, usually occurs at 20-50 years of age Examination: Skin findings as above Enlarged spleen Laboratory: Low platelets -- may even be below 100,000/milliliter Platelets that are present are slightly enlarged (megathrombocytes) Hemolytic anemia is present in 10% (but no red cell fragmentation) PT and PTT (measure clotting factors of blood) tests are often normal Bone Marrow Biopsy is normal Quantitative anti-platelet IgG antibody measurements may aid in diagnosis (very sensitive, but not specific) Avoid aspirin and anti-inflammatory medications (e.g., ibuprofen) Prednisone -- A high dose will usually raise platelets quickly, while a low dose is usually needed for maintenance. Splenectomy (surgical removal of the spleen) will cure the disease. High dose intravenous immunoglobulin for severe disease to raise the platelets quickly. It is very expensive so it is usually only used for 1- 5 days (the benefit lasts 1-2 weeks). Danazol helps some persons who fail both prednisone and splenectomy. Platelet transfusions are used for life-threatening bleeding only because these platelets are just as likely to be destroyed as the body's own platelets. Drug-induced thrombocytopenia Chronic Lymphocytic Leukemia Hypersplenism