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Idiopathic Thrombocytopenic Purpura Follow-up

  • Author: Michael A Silverman, MD, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
 
Updated: Jul 22, 2016
 

Further Outpatient Care

See the list below:

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

See the list below:

  • 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.
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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.
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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
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Prognosis

Approximately 83% of children have a spontaneous remission, and 89% of children eventually recover. More than 50% recover within 4-8 weeks. Approximately 2% die.

Only 2% of adults have a spontaneous recovery; however, approximately 64% of adults eventually recover. Approximately 30% have chronic disease, and 5% die from hemorrhage.

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Patient Education

See the list below:

  • 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.
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Contributor Information and Disclosures
Author

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

Michael A Silverman, MD, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Gil Z Shlamovitz, MD, FACEP Associate Professor of Clinical Emergency Medicine, Keck School of Medicine of the University of Southern California; Chief Medical Information Officer, Keck Medicine of USC

Gil Z Shlamovitz, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association

Disclosure: Nothing to disclose.

Additional Contributors

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

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

Disclosure: Nothing to disclose.

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