Itp
Download as PPTX, PDF9 likes2,656 views
ITP, or idiopathic thrombocytopenic purpura, is a bleeding disorder caused by low platelet count due to autoimmune antibodies. It is classified as either acute (lasting less than 6 months) or chronic (lasting more than 6 months). Common symptoms include purpura (bruising) and mucous membrane bleeding. Diagnosis is based on isolated thrombocytopenia on CBC and absence of other causes. Treatment for mild cases is usually observation, while severe cases may require corticosteroids, IVIG, or splenectomy as a last resort treatment.
Itp
- 1. ILA : IDIOPATHIC /IMMUNE THROMBOCYTOPENIC PURPURA (ITP)/ PURPURA HEMORRHAGICA / ESSENTIAL THROMBOCYTOPENIA.
- 2. What is ITP? Bleeding disorder where the blood doesn't clot as it should due to low number or platelet • Immune : there is autoimmune antibodies in their blood • Thrombocytopenic : thrombocyte/platelet count below 100,000 per microliter. •Purpura :purplish or reddish-brown skin rash caused by the leakage of blood from broken capillaries into the skin.
- 3. PATHOGENESIS
- 4. CLINICAL PICTURE Acute chronic 85-90% cases 10 % cases Self limited within 6 months (platelet return to normal) Thrombocytopenia > 6 months Mostly children 2-8 years History of viral infection in preceding 1-4 weeks
- 5. CLINICAL PICTURE – Acute
- 6. DIFFERENTIAL DIAGNOSIS OF ITP •Disseminated Intravascular Coagulation •Thrombotic Thrombocytopenic Purpura •Myelodysplastic Syndrome •Acute leukemia •Drug-induced thrombocytopenia •Hemolytic-uremic syndrome (HUS) •Human immunodeficiency virus (HIV) •Hypersplenism •Liver disease •Lymphoma •Malignancy •Posttransfusion reaction •Pregnancy induced thrombocytopenia •Sepsis •Systemic lupus erythematosus (SLE)
- 7. Investigations 1. CBC: • Isolated thrombocytopenia: Always <100,000 and often <20,000/mm3 • Normocytic normochromic anemia only if due to significant bleeding 2. Bleeding time is prolonged (normal: 2-5 minutes) 3. Coagulation time (4-8 min), prothrombin time and partial thromboplastin time is normal
- 8. 4. Clot retraction: Poor or absent 5. Bone marrow examination: • Megakaryocytes: Normal or increase number with decrease or absent budding • Granulocytic and erythrocytic series are normal 4. ANA in adolescents (to rule out SLE) 5. Coombs’ test if there is anemia 6. Test for HCV and HIV for the newly diagnosed adult patients with ITP
- 9. TREATMENT OF ITP Mild case : platelets more than 30,000/mm3 -mild bruising - No treatment (only observation) except preparation for surgery. - Avoid trauma and violent sport. Severe case : platelet less than 20,000/mm3 -marked bruising -mucous membrane bleeding -CNS bleeding
- 10. 1st line therapy • Oral corticosteroids (1mg/kg weight of patient) - Response to 2/3 of the patients. - Relapse is usual when the dose is reduced. • Intravenous immunoglobulin (IgG) -give especially before surgery -rapid rise in desired platelet count.
- 11. 2nd line therapy • Splenectomy (last resort) – give respond to majority of cases - Indications 1) Emergency in acute severe ITP (ie : intracranial haemorrhage) 2) Chronic ITP not respond to medical treatment If fail : 1) High dose corticosteroids 2) IV anti D for Rh+ 3) Vinca alkaloids 4) Danazol 5) Immunosuppresive drugs (azothiopine,cyclosporine,dapsone) 6) Thrombopoiesis protein( Rituximab,Romiplostin)