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Idiopathic thrombocytopenic purpura
Idiopathic thrombocytopenic purpura is also known as immune
thrombocytopenic purpura.
Idiopathic thrombocytopenic purpura is the condition of having a low
platelet count (thrombocytopenia) of no known cause (idiopathic).
Signs and symptoms
Often, low platelet counts are picked up by coincidence when a full
blood count has been ordered for routine testing. Occasionally, ITP
patients suffer from bruising, nosebleeds, and bleeding gums. This
normally does not occur unless the platelet count is very low (10,000
per mm3).
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Diagnosis
Low platelet count can be a feature of a large number of diseases and,
when serious, warrants investigation by a haematology. In many cases,
the cause is not really idiopathic but autoimmune, although antibodies
against platelets are only detected in a minority.
Treatment
Mild ITP does not require treatment. When platelet counts fall under
10,000 per milliliter, or under 50,000 when hemorrhage occurs (e.g. in
the digestive tract or in a severe nosebleed) treatment is generally
initiated with steroids, and later with so-called steroid-sparing agents
(alternatively called DMARDs). When these strategies fail, splenectomy
(removal of the spleen) is often undertaken, as platelets targeted for
destruction will often meet their fate in the spleen. A relatively new
strategy is treatment with anti-D, an agent used in mothers who have
been sensitised to rhesus antigen by a Rh+ baby. Extreme cases (very
rare, especially rare in children) may require vincristine, a
chemotherapy agent, to stop the immune system from destroying platelets.
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