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Idiopathic thrombocytopenic purpura - Skin in Adult
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Idiopathic thrombocytopenic purpura - Skin in Adult

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Contributors: Noah Craft MD, PhD, Lindy P. Fox MD, Lowell A. Goldsmith MD, MPH, Michael D. Tharp MD
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Synopsis

Immune thrombocytopenic purpura (ITP), also known as idiopathic thrombocytopenic purpura, is an autoimmune disease in which platelet counts become decreased and manifests as a bleeding tendency. ITP patients have circulating antibodies that cause platelet destruction, the spleen being the primary site for destruction of circulating platelets. Platelet production may also be affected.

Severity of signs and symptoms varies according to the platelet levels. Patients with platelet counts of between 30 000 and 50 000 usually present with a complaint of easy bruising, whereas platelet levels of 10 000 to 20 000 lead to more significant petechiae, purpura, or ecchymoses.

Although usually idiopathic, ITP may be secondary to a number of conditions, and it is important to exclude these conditions before diagnosing ITP. Secondary thrombocytopenia may be drug induced, alcohol related, or caused by chronic liver disease. It may occur in connection with other autoimmune disorders such as systemic lupus erythematosus, antiphospholipid antibody syndrome, thyroid disease and autoimmune hemolytic anemia, lymphoproliferative disorders, and HIV infections.

ITP may be acute or chronic, and the 2 forms are differentiated by the duration of illness, the age groups affected, and the treatment approach. The acute form is more common in children, in whom it tends to be a self-limiting disease. In adults, the chronic form is the type more commonly seen, although acute ITP may also occur. The chronic form lasts longer than 6 months and usually requires treatment. In the chronic type, females show a 3:1 incidence compared with males, with onset usually between the ages of 20 and 40.

One hundred new cases per million each year develop, with half of them being children.

Signs and symptoms of ITP include purpura, epistaxis, easy bruising, bleeding gums, and menorrhagia. More severe or fatal bleeding, such as intracranial hemorrhage, hematuria, hemoptysis, and gastrointestinal bleeding, is rare.  

The incidence and severity increases with age.

Codes

ICD10CM:
D69.3 – Immune thrombocytopenic purpura

SNOMEDCT:
32273002 – Idiopathic thrombocytopenic purpura

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated: 06/21/2017
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Idiopathic thrombocytopenic purpura - Skin in Adult
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Idiopathic thrombocytopenic purpura : Easy bruising, Ecchymosis, Epistaxis, Gingival bleeding, PLT decreased
Clinical image of Idiopathic thrombocytopenic purpura
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