Idiopathic Thrombocytopenic Purpura 

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

Background

Idiopathic thrombocytopenic purpura (ITP), also known as primary immune thrombocytopenic purpura and autoimmune thrombocytopenic purpura, is defined as isolated thrombocytopenia with normal bone marrow and the absence of other causes of thrombocytopenia. The 2 distinct clinical syndromes manifest as an acute condition in children and a chronic condition in adults.

ITP is a decrease in the number of circulating platelets in the absence of toxic exposure or a disease associated with a low platelet count.

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Pathophysiology

ITP is primarily a disease of increased peripheral platelet destruction, with most patients having antibodies to specific platelet membrane glycoproteins. Relative marrow failure may contribute to this condition, since studies show that most patients have either normal or diminished platelet production.

Acute ITP often follows an acute infection and has a spontaneous resolution within 2 months. Chronic ITP persists longer than 6 months without a specific cause.

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Epidemiology

Frequency

United States

The incidence of ITP in adults is approximately 66 cases per 1,000,000 per year.

An average estimate of the incidence in children is 50 cases per 1,000,000 per year.

New cases of chronic refractory ITP comprise approximately 10 cases per 1,000,000 per year.

International

According to studies in Denmark and England, childhood ITP occurs in approximately 10-40 cases per 1,000,000 per year. A study in Kuwait reported a higher incidence of 125 cases per 1,000,000 per year.

Mortality/Morbidity

  • Hemorrhage represents the most serious complication; intracranial hemorrhage is the most significant. The mortality rate from hemorrhage is approximately 1% in children and 5% in adults. In patients with severe thrombocytopenia, predicted 5-year mortality rates from bleeding are significantly raised in patients older than 60 years versus patients younger than 40 years, 47.8% versus 2.2%, respectively.
  • Older age and previous history of hemorrhage increase the risk of severe bleeding in adult ITP.
  • Spontaneous remission occurs in more than 80% of cases in children but is uncommon in adults.

Sex

  • In chronic ITP (adults), the female-to-male ratio is 2.6:1. More than 72% of patients older than 10 years are female.
  • In acute ITP (children), distribution is equal between males (52%) and females (48%).

Age

  • Peak prevalence occurs in adults aged 20-50 years.
  • Peak prevalence occurs in children aged 2-4 years.
  • Approximately 40% of all patients are younger than 10 years.
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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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