eMedicine Specialties > Emergency Medicine > Hematology & Oncology

Idiopathic Thrombocytopenic Purpura: Follow-up

Author: Michael A Silverman, MD, Instructor of Emergency Medicine, The Johns Hopkins University School of Medicine; Chairman, Department of Emergency Medicine, Harbor Hospital
Contributor Information and Disclosures

Updated: Jan 21, 2009

Follow-up

Further Inpatient Care

  • Rule out other potential causes of thrombocytopenia.
  • Emergency splenectomy may be necessary if severe bleeding complications due to thrombocytopenia do not respond to medical therapy.
  • Observe for life-threatening bleeding.
  • Consult with a hematologist, as further treatments (eg, steroids, IVIg, platelet transfusion) may be indicated.

Further Outpatient Care

  • Close follow-up care with a hematologist is required.
  • Elective splenectomy may be necessary if medical therapy fails.

Transfer

  • Transfer may be necessary under the following conditions:
    • A hematologist is not available.
    • Blood bank support is insufficient.
    • A higher level of intensive care is needed.

Complications

  • Complications of idiopathic thrombocytopenic purpura may include the following:
    • Intracranial or other major hemorrhage
    • Severe blood loss
    • Adverse effects of corticosteroids
    • Pneumococcal infections if the patient must have a splenectomy

Prognosis

  • Children
    • Approximately 83% of children have a spontaneous remission, and 89% of children eventually recover.
    • More than 50% of patients recover within 4-8 weeks.
    • Approximately 2% of patients die.
  • Adults
    • Only 2% of adults have a spontaneous recovery; however, approximately 64% of adults eventually recover.
    • Approximately 30% of patients have chronic disease, and 5% of patients die from hemorrhage.

Patient Education

  • Instruct patients to return for follow-up in order to assess for a potentially reduced platelet count.
  • Emphasize close outpatient follow-up care.
  • Because of the increased risk of bleeding, instruct patients to avoid aspirin products.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider other causes of thrombocytopenia
  • Failure to initiate therapy

Special Concerns

  • Pregnancy
    • Gestational thrombocytopenia and thrombocytopenia due to preeclampsia are more common than ITP in pregnancy.
    • Pregnancy does not increase the incidence of ITP, and it does not exacerbate a preexisting disease.
    • The pregnant patient with ITP is treated the same as other patients with ITP.
    • Concerns about thrombocytopenia increase as term approaches, and the risks of thrombocytopenia to the newborn must be considered. This is because antiplatelet IgG antibodies can cross the placenta and can induce fetal thrombocytopenia. 
    • The perinatologist and the hematologist make the ultimate decisions regarding cesarean section (for protection of the newborn against intracranial hemorrhage), percutaneous umbilical blood sampling, prednisone, and IVIg therapy.
  • Geriatrics: Patients older than 60 years may be at greater risk of severe bleeding than younger patients (<40 y) at equivalent platelet counts.
 


More on Idiopathic Thrombocytopenic Purpura

Overview: Idiopathic Thrombocytopenic Purpura
Differential Diagnoses & Workup: Idiopathic Thrombocytopenic Purpura
Treatment & Medication: Idiopathic Thrombocytopenic Purpura
Follow-up: Idiopathic Thrombocytopenic Purpura
References
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Further Reading

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Keywords

idiopathic thrombocytopenic purpura, ITP, platelets, primary immune thrombocytopenic purpura, autoimmune thrombocytopenic purpura, thrombocytopenia, hemorrhage, acute ITP, childhood ITP, adult ITP, purpura, isolated thrombocytopenia, splenectomy, platelet count, decrease in number of platelets, increased destruction of platelets, chronic refractory ITP, intracranial hemorrhage, bleeding, menorrhagia, epistaxis, gingival bleeding, recent live virus immunization, recent viral illness, bruising tendency, nephritis,cutaneous vasculitis, arthritis, HIV, petechiae, hemorrhagic bullae, menometrorrhagia, retinal hemorrhages, spontaneous bleeding, immunoglobulin G autoantibodies

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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.

Medical Editor

Edward A Michelson, MD, Program Director, Associate Professor, 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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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.

CME Editor

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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