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Immune thrombocytopenic purpura in Child
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Immune thrombocytopenic purpura in Child

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Contributors: Craig N. Burkhart MD, Dean Morrell MD, Lowell A. Goldsmith MD, MPH
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Synopsis

Immune thrombocytopenic purpura (ITP), also known as idiopathic thrombocytopenic purpura, is a condition in which platelet counts become decreased. ITP may be acute or chronic, with the acute form being more common in children, in whom it tends to be a self-limiting disease, and the chronic form more prevalent in adults.

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 10 000-20 000 lead to more significant petechiae, purpura, or ecchymoses.

Acute ITP may follow a viral infection or upper respiratory tract infection and is the most common etiology in children, accounting for more than 90% of cases. Inquire about a history of recent immunization or drug intake. Autoimmune disorders, either in the child or other family members, should be queried. An antiplatelet antibody, of the IgG class, is thought to be the causative agent leading to thrombocytopenia. 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 the possibility of human immunodeficiency virus (HIV) infection.

Children present with mucosal bleeding from the gums and nostrils and petechiae and purpura on the extremities that is not linked to trauma. Blood in the urine or in stool may be present.

Fatal hemorrhage, although rare, represents a serious complication, the most significant being intracranial hemorrhage, which leads to neurological signs and symptoms such as headache, altered mental status, ataxia, and blurred vision.

Even though platelet counts are very low, a significant number of children (greater than 80%) have mild clinical signs and symptoms and rarely serious bleeding. ITP presents equally among boys and girls, with an approximate incidence of 50 cases per 1 000 000 each year.

Recovery is usually spontaneous and occurs completely within a few days to weeks in most cases. The remainder of children recover within 3-6 months. If the ITP lasts for more than 6 months, it is then classified as chronic.

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: 09/17/2019
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Immune thrombocytopenic purpura in Child
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Immune thrombocytopenic purpura : Easy bruising, Ecchymosis, Epistaxis, Gingival bleeding, PLT decreased
Clinical image of Immune thrombocytopenic purpura
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