Idiopathic Thrombocytopenic Purpura (ITP) in Emergency Medicine Clinical Presentation

Updated: Nov 04, 2017
  • Author: Michael A Silverman, MD, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Presentation

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 three 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 three 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

See the list below:

  • Immunoglobulin G (IgG) autoantibodies on the platelet surface

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