Idiopathic Thrombocytopenic Purpura Clinical Presentation

  • Author: Michael A Silverman, MD; Chief Editor: Pamela L Dyne, MD   more...
 
Updated: Jan 21, 2011
 

History

  • Focus on the symptoms of bleeding (eg, type, severity, duration) and on symptoms that may exclude other causes of thrombocytopenia.
  • Elicit risk factors for HIV and systemic symptoms linked to other illnesses or to medications (eg, heparin, alcohol, quinidine/quinine, sulfonamides) that may cause thrombocytopenia. Medications can be a common etiology for inducing thrombocytopenia, and patients should have their medications carefully reviewed. One study used 3 distinct methods to document drugs that may be associated with drug-induced immune thrombocytopenia (DITP).[1, 2] Approximately 1500 drugs are associated with thrombocytopenia, but, using this analysis, 24 drugs had evidence of causing thrombocytopenia by all 3 methods.
  • Address risk factors for increased bleeding, such as GI disease, CNS disease, urologic disease, or active lifestyle, as these may determine the aggressiveness of management.
  • Common signs, symptoms, and precipitating factors include the following:
    • Abrupt onset (childhood ITP)
    • Gradual onset (adult ITP)
    • Purpura
    • Menorrhagia
    • Epistaxis
    • Gingival bleeding
    • Recent live virus immunization (childhood ITP)
    • Recent viral illness (childhood ITP)
    • Bruising tendency
  • Limited data are available on the recurrent form of the disease. One study showed a 6% prevalence of recurrent ITP with most patients (69%) having only one recurrence. Though one third of patients had their recurrent episode within 3 months of their initial one, the remainder of patients had at least a 3-month interval between episodes.
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Physical

Evaluate the type and the severity of bleeding and try to exclude other causes of bleeding. Seek evidence of liver disease, thrombosis, autoimmune diseases (eg, nephritis, cutaneous vasculitis, arthritis), and infection, particularly HIV.

Common physical findings include the following:

  • Nonpalpable petechiae, which mostly occur in dependent regions
  • Hemorrhagic bullae on mucous membranes
  • Purpura
  • Gingival bleeding
  • Signs of GI bleeding
  • Menometrorrhagia, menorrhagia
  • Retinal hemorrhages
  • Evidence of intracranial hemorrhage, with possible neurologic symptoms
  • Nonpalpable spleen: The prevalence of palpable spleen in patients with ITP is approximately the same as that in the non-ITP population (ie, 3% in adults, 12% in children).
  • Spontaneous bleeding when platelet count is less than 20,000/mm3.
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Causes

  • Immunoglobulin G (IgG) autoantibodies on the platelet surface
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Contributor Information and Disclosures
Author

Michael A Silverman, MD  Instructor of Emergency Medicine, The Johns Hopkins University School of Medicine; Chairman, Department of Emergency Medicine, Harbor Hospital

Michael A Silverman, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Physician Executives, and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Edward A Michelson, MD  Associate Professor, Program Director, Department of Emergency Medicine, University Hospital Health Systems in Cleveland

Edward A Michelson, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Jeffrey L Arnold, MD, FACEP  Chairman, Department of Emergency Medicine, Santa Clara Valley Medical Center

Jeffrey L Arnold, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD  Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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