Immune thrombocytopenic purpura (peds) - Revision history

Ostermayer at 20:50, 17 January 2026

2026-01-17T20:50:46Z

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	{{~~Peds top}} [[~~Immune thrombocytopenic purpura~~]] or [[~~ITP in Pregnancy~~]] for pregnancy related.''~~		{{PediatricPage\|Immune thrombocytopenic purpura\|ITP in Pregnancy}}
	==Background==		==Background==
	* Also known as immune thrombocytopenia (ITP), an acquired immune-mediated thrombocytopenia		* Also known as immune thrombocytopenia (ITP), an acquired immune-mediated thrombocytopenia

Rossdonaldson1 at 18:33, 31 January 2024

2024-01-31T18:33:38Z

← Older revision		Revision as of 18:33, 31 January 2024
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	{{Peds top}} [[Immune thrombocytopenic purpura]].''		{{Peds top}} [[Immune thrombocytopenic purpura]] or [[ITP in Pregnancy]] for pregnancy related.''
	==Background==		==Background==
	* Also known as immune thrombocytopenia (ITP), an acquired immune-mediated thrombocytopenia		* Also known as immune thrombocytopenia (ITP), an acquired immune-mediated thrombocytopenia

Rossdonaldson1 at 18:32, 31 January 2024

2024-01-31T18:32:38Z

← Older revision		Revision as of 18:32, 31 January 2024
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	==Clinical Features==		==Clinical Features==
			[[File:Purpura.jpg\|thumb\|Petechiae in a patient with ITP.]]
			[[File:Petechia on the tongue.jpg\|thumb\|Petechiae on the tongue in a patient with ITP.]]
			[[File:Petechia lower leg2.jpg\|thumb\|Petechiae on the lower leg in a patient with ITP.]]
			[[File:PMC4192833 TODENTJ-8-164 F1.png\|thumb\|Unprovoked gingival bleeding as a presenting symptom in ITP.]]
	*Usually well-appearing without constitutional symptoms		*Usually well-appearing without constitutional symptoms
	*Isolated petechial rash or bruising is often the first clinical feature		*Isolated petechial rash or bruising is often the first clinical feature

Rossdonaldson1: /* Background */

2024-01-24T22:36:47Z

Background

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	* Primary peak is in early childhood (2-5 years) with a smaller peak in adolescence		* Primary peak is in early childhood (2-5 years) with a smaller peak in adolescence
	* ITP is a diagnosis of exclusion; first consider all serious causes of petechiae/purpura including [[meningococcemia]], [[DIC]], [[HUS]], [[TTP]], [[Leukemia]], etc		* ITP is a diagnosis of exclusion; first consider all serious causes of petechiae/purpura including [[meningococcemia]], [[DIC]], [[HUS]], [[TTP]], [[Leukemia]], etc

			{{Acute vs chronic ITP}}

	==Clinical Features==		==Clinical Features==

Patricklin at 00:51, 10 January 2024

2024-01-10T00:51:49Z

← Older revision		Revision as of 00:51, 10 January 2024
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	{{Peds top}} [[Immune thrombocytopenic purpura]].''		{{Peds top}} [[Immune thrombocytopenic purpura]].''
	==Background==		==Background==
	* Also known as immune thrombocytopenia (ITP)		* Also known as immune thrombocytopenia (ITP), an acquired immune-mediated thrombocytopenia
	* Autoantibodies to platelet membrane antigens ~~clear~~ platelets and limit production		** Hallmark is isolated thrombocytopenia
	* Can be primary or secondary (medications, systemic illness, infection)		* Pathophysiology: Autoantibodies to platelet membrane antigens (ex. GpIIb//IIIa) lead to splenic clearance of platelets and limit production
	* Hallmark is isolated thrombocytopenia		* Can be primary or secondary (medications, systemic illness, infection, autoimmune disorder)
	* Primary peak is in early childhood (2-5 years) with a smaller peak in adolescence		* Primary peak is in early childhood (2-5 years) with a smaller peak in adolescence
	* ITP is a diagnosis of exclusion		* ITP is a diagnosis of exclusion; first consider all serious causes of petechiae/purpura including [[meningococcemia]], [[DIC]], [[HUS]], [[TTP]], [[Leukemia]], etc

	==Clinical Features==		==Clinical Features==
	* Usually well appearing without constitutional symptoms		*Usually well-appearing without constitutional symptoms
	* May have a preceding systemic illness		*Isolated petechial rash or bruising is often the first clinical feature
	* May have exposure to recent vaccinations (particularly MMR) or drugs known to cause thrombocytopenia: Heparin, Quinidine, Phenytoin, Sulfa drugs, Valproate and Vancomycin		**Most have "dry" bleeding consisting of [[petechiae]], [[purpura]], and ecchymoses
	* May have bleeding, but this may be absent		**May have "wet" bleeding such as oral/nasal bleeding
	** Most have dry bleeding consisting of [[petechiae]], [[purpura]], and ecchymoses		** Severe or intracranial bleeding is rare, but have a high index of suspicion in the appropriate context
	** Can see mucosal bleeding		*May have a preceding systemic illness
	** Severe or intracranial bleeding are rare		**>70% of pediatric cases occur after viral infections<ref> Deepak M. Kamat; Immune Thrombocytopenia Purpura. Quick References 2020; 10.1542/aap.ppcqr.396184</ref>
			*May have exposure to recent vaccinations (particularly MMR) or drugs known to cause thrombocytopenia: Heparin, Quinidine, Phenytoin, Sulfa drugs, Valproate and Vancomycin

	==Differential Diagnosis==		==Differential Diagnosis==
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	===Workup===		===Workup===
	*CBC		*CBC
			*Peripheral blood smear to assess for atypical cell lines, hemolytic anemia, and platelet quantity/quality
			*Coags if heavy bleeding
			**Results are typically normal in ITP
			*Type and Screen
			**Blood typing can determine Rh status; only Rh+ patients should be treated with [[RhoGAM]]
			**RhoGAM coats RBCs to later bind Fc gamma receptor in the reticuloendothelial system (spleen), which interferes with the removal of antibody-coated platelets
			*There is no role for antiplatelet antibody testing due to lack of sensitivity/specificiy<ref>Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB, Chong BH, Cines DB, Gernsheimer TB, Godeau B, Grainger J, Greer I, Hunt BJ, Imbach PA, Lyons G, McMillan R, Rodeghiero F, Sanz MA, Tarantino M, Watson S, Young J, Kuter DJ. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010 Jan 14;115(2):168-86. doi: 10.1182/blood-2009-06-225565. Epub 2009 Oct 21. PMID: 19846889.</ref>

	===Diagnosis===		===Diagnosis===
	* Platelet count of < 100,000/microL is usually the only finding on a CBC		* Platelet count of < 100,000/microL is usually the only finding on a CBC
	** Usually < 30,000/microL.		**Consider alternate diagnoses, including leukemia/lymphoma, when other cell lines are abnormal
	* Remainder of the CBC is typically normal, unless there is significant bleeding (Hgb could be low)		** Usually < 30,000/microL.
			* Remainder of the CBC is typically normal, unless there is significant bleeding (Hgb could be low)
	* Peripheral blood smear shows fewer than normal platelets and increased mean platelet volume (due to younger, larger platelets/megakaryocytes)		* Peripheral blood smear shows fewer than normal platelets and increased mean platelet volume (due to younger, larger platelets/megakaryocytes)
			**Leukocytes and RBCs should be morphologically normal

	==Management==		==Management==
	* Consult pediatric hematologist		* Consult pediatric hematologist
	* Avoid activity that could increase risk of trauma		* Avoid activity that could increase risk of trauma, especially head trauma
	* Avoid [[NSAIDs]] and [[anticoagulants]]		* Avoid [[NSAIDs]] and [[anticoagulants]]
	* Therapy is based on degree of bleeding		* Therapy is based on degree of bleeding; first-line therapy includes different combinations of [[corticosteroids]] and [[IVIG]] or [[RhoGAM]] (use only for Rh+ patients)
			** Most children (85%) have a self-resolving course and do not require treatment.<ref>Justiz Vaillant AA, Gupta N. ITP-Immune Thrombocytopenic Purpura. [Updated 2023 May 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.</ref>
	** Low-risk bleeding: Watchful waiting		** Low-risk bleeding: Watchful waiting
	** Moderate to high-risk bleeding: [[IVIG]] or [[RhoGAM]] if significant bleeding or if preparing for procedure		** Moderate to high-risk bleeding: [[IVIG]] or [[RhoGAM]] if significant bleeding or if preparing for procedure
	** Severe bleeding, non-life threatening: [[Platelet transfusion]] if needed. [[Methylprednisolone]], IVIG and/or [[RhoGAM]] for up to 4 days. Possibly Romiplostim (thrombopoietin receptor agonist) or TXA.		** Severe bleeding, non-life threatening: [[Platelet transfusion]] if needed. [[Methylprednisolone]], IVIG and/or [[RhoGAM]] for up to 4 days. Possibly Romiplostim (thrombopoietin receptor agonist) or TXA.
	** Life threatening bleeding: [[Platelet transfusion]], [[methylprednisolone]] x 3-4 days, [[IVIG]] x 1-3 days.		** Life threatening bleeding: [[Platelet transfusion]], [[methylprednisolone]] x 3-4 days, [[IVIG]] x 1-3 days.

Rossdonaldson1: /* References */

2022-10-19T18:58:05Z

References

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	==References==		==References==
	Duncan, Ellen. Immune Thrombocytopenia. ''PEM GUIDES''. 7th edition. NYU Langone Health; 2020: 459-462.		*Duncan, Ellen. Immune Thrombocytopenia. ''PEM GUIDES''. 7th edition. NYU Langone Health; 2020: 459-462.

	[[Category:Pediatrics]]		[[Category:Pediatrics]]

Rossdonaldson1: /* See Also */

2022-10-19T18:52:33Z

Rossdonaldson1: /* References */

2022-10-19T18:50:14Z

References

← Older revision		Revision as of 18:50, 19 October 2022
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	Duncan, Ellen. Immune Thrombocytopenia. ''PEM GUIDES''. 7th edition. NYU Langone Health; 2020: 459-462.		Duncan, Ellen. Immune Thrombocytopenia. ''PEM GUIDES''. 7th edition. NYU Langone Health; 2020: 459-462.

	[[Category:~~Peds~~]]		[[Category:Pediatrics]]

Rossdonaldson1: /* Management */

2022-10-19T18:49:52Z

Management

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	* Consult pediatric hematologist		* Consult pediatric hematologist
	* Avoid activity that could increase risk of trauma		* Avoid activity that could increase risk of trauma
	* Avoid NSAIDs and anticoagulants		* Avoid [[NSAIDs]] and [[anticoagulants]]
	* Therapy is based on degree of bleeding		* Therapy is based on degree of bleeding
	** Low-risk bleeding: Watchful waiting		** Low-risk bleeding: Watchful waiting

Rossdonaldson1: /* Workup */

2022-10-19T18:49:33Z

Workup

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	{{Thrombocytopenia}}		{{Thrombocytopenia}}

	==Workup==		==Evaluation==
			===Workup===
			*CBC

			===Diagnosis===
	* Platelet count of < 100,000/microL is usually the only finding on a CBC		* Platelet count of < 100,000/microL is usually the only finding on a CBC
	** Usually < 30,000/microL.		** Usually < 30,000/microL.

← Older revision		Revision as of 18:52, 19 October 2022
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	==See Also==		==See Also==
	* [[ITP]]		*[[ITP]] (adult)
			*[[ITP in Pregnancy]]
			*[[TTP]]

	==References==		==References==