Immune thrombocytopenic purpura in Adult
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 human immunodeficiency virus (HIV) infection.
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 (GI) bleeding, is rare.
The incidence and severity increases with age.
D69.3 – Immune thrombocytopenic purpura
32273002 – Idiopathic thrombocytopenic purpura
- Post-viral ITP (cytomegalovirus, Epstein-Barr virus, varicella-zoster virus)
- Thrombotic thrombocytopenic purpura
- Disseminated intravascular coagulation
- Hemolytic uremic syndrome
- Lymphoma, Hodgkin lymphoma
- Rocky Mountain spotted fever
- Systemic lupus erythematosus
- Drug- or radiation-induced aplastic anemia (drugs include heparin, quinine / quinidine, sulfonamides)
- Heparin-induced thrombocytopenia
- Other infection (hepatitis B, hepatitis C, Helicobacter pylori)
- Thrombocytopenia in patients with AIDS
- Liver disease
- Renal disease
- Myelodysplastic syndromes, acute leukemia
- Chronic lymphocytic leukemia
- Evans syndrome
- Rheumatoid arthritis
- Antiphospholipid antibody syndrome