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Immune thrombocytopenia (formerly idiopathic thrombocytopenic purpura [ITP]) occurs because of platelet injury and destruction. Pinpoint, red, nonblanching petechiae or nonpalpable purpura and ecchymoses are found on the skin and mucous membranes, either spontaneously (platelets < 10,000/mm3) or at the site of minimal trauma (platelets < 40,000/mm3). Petechiae are commonly found on dependent areas. Gingival bleeding, melena, hematochezia, menorrhagia, and severe intracranial hemorrhages may also occur. The newly diagnosed form affects children (peak incidence in 2- to 4-year-olds, equal gender distribution) after a viral illness or vaccination and completely resolves in 3 months. The chronic form occurs most often in adults, with women outnumbering men and a prolonged course of thrombocytopenia.
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Management and Disposition
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Consult hematology for medical management guidance. Treatment can include observation, oral or systemic corticosteroids, IVIG, rituximab, thrombopoietin receptor agonists, and platelet transfusions alone or in combination.
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Isolated thrombocytopenia is the hallmark finding; white blood cell, hemoglobin, and coagulation levels should be normal (if no major hemorrhage).
Patients with advanced age, comorbidities, and prior history of hemorrhage have a high risk of associated bleeding (eg, central nervous system). In addition, adults have a higher incidence of thromboembolism. Keep a low threshold for working up these patients and insist on appropriate disposition.
The newly diagnosed form of immune thrombocytopenia (symptoms < 3 months in duration) has an excellent prognosis, whereas chronic immune thrombocytopenia (symptoms > 12 months in duration) has varying severity.
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