IDIOPATHIC THROMBOCYTOPENIC
PURPURA
INTRODUCTION
It is an autoimmune disorder characterized by antibody- mediated
destruction of platelets.
It is a self-limiting disorder, which usually resolves spontaneously
within a few months of onset.
It can occur at any age.
Incidence is 4 to 8 per 1000 per year
DEFINITION OF IDIOPATHIC THROMBOCYTOPENIC
PURPURA
Idiopathic thrombocytopenic purpura is a blood disorder characterized by
an abnormal decrease in the number of platelets in blood. It can result
in easy bruising, bleeding gums and internal bleeding .
1)AUTOIMMUNE THROMBOCYTOPENIC PURPURA
ITP is a disease that affects people of all ages, but it is more common among
children and young women.
There are two forms of ITP
Acute Thrombocytopenic Purpura
Chronic Thrombocytopenic Purpura
ACUTE ITP
-AGE GROUP: MORE COMMON IN CHILDREN <10 YEARS (EQUAL IN
MALES/FEMALES).
- DURATION: RESOLVES WITHIN 6 MONTHS (NO RELAPSE).
- SEASONALITY: MORE PREVALENT IN LATE WINTER/SPRING.
- CAUSE: OFTEN FOLLOWS VIRAL INFECTIONS (E.G., MEASLES, CHICKENPOX).
- PLATELET COUNT: RETURNS TO NORMAL SPONTANEOUSLY (85–90% OF CASES).
1. - SYMPTOMS: SUDDEN PURPURA, PETECHIAE, MUCOSAL BLEEDING (E.G.,
EPISTAXIS).
CHRONIC ITP
-AGE GROUP: ADOLESCENTS > YOUNGER CHILDREN; MORE FREQUENT IN FEMALES.
- DURATION: THROMBOCYTOPENIA PERSISTS >6 MONTHS.
- ASSOCIATION: LINKED TO AUTOIMMUNE DISORDERS (E.G., SLE, COLLAGEN
VASCULAR DISEASES).
- SYMPTOMS: PERSISTENT BLEEDING (E.G., MENORRHAGIA, GI BLEEDING), MAY
DEVELOP SLE LATER.
1. - DIAGNOSIS: NORMAL BONE MARROW, ISOLATED LOW PLATELETS, NO
HEPATOSPLENOMEGALY.
CLINICAL MANIFESTATION OF THROMBOCYTOPENIC
PURPURA
A healthy child with purpuric spots over the skin and mucous
membrane of sudden onset.
Preceding history of viral upper respiratory tract infection,
measles, chickenpox, pertussis, etc. Within 4-6 weeks before
appearance.
Petechiae and ecchymosis.
GI bleeding, hematuria, epistaxis, gum bleeding, menorrhagia
in adolescents and sometimes CNS bleeding
No anemia.
No hepatosplenomegaly or lymphadenopathy.
DIAGNOSTIC TEST OF THROMBOCYTOPENIC PURPURA
• History collection
• Physical examination
• Complete blood count: Platelet count below 1 lac/cubic mm. Normal
leukocyte count, RBC count and no anemia.
• Peripheral blood smear: Morphology of platelets and RBC is normal.
• Bone marrow examination: Usually not required, unless features in
peripheral smear suggest aplastic anemia or ALL.
• Investigations for SLE and HIV infection.
MEDICAL MANAGEMENT
Aim of treatment is to prevent life threatening bleeding.
Corticosteroids
Monoclonal Antibodies ( anti- CD20 rituximab)
Intravenous immunoglobulin (IVIG)
Platelet transfusion
Chemotherapy agents
I/V Anti-D therapy for Rh- positive patient , dose of 50- 75microgram/kg
SURGICAL MANAGEMENT
SPLENECTOMY: May be considered , as platelets which have been
bound by antibodies are taken by macrophages in the spleen. Spleen
is the main site for the production of antibodies & destruction of
antibody – coated platelets. If the bleeding is refractory to IVIG ,
splenectomy should be performed.
NURSING MANAGEMENT
ASSESSMENT
Assess the skin color for bruising, ecchymosis, petechiae.
Observe the & report the amount and location of bleeding episodes.
Check the laboratory investigations such as platelet count daily.
Assess the hydration status of patient.
NUSING INTERVENTIONS
Monitor vital sign & record 6 hourly & report any deterioration.
Encourage the patient to eat dark green leafy vegetables. They
promote clotting.
Secure IV line for fluids , medication & possibly blood transfusion.
Apply pressure on puncture sites for 5 to 10 minutes.
Monitor stool, urine and vomitus for blood.
Apply infection prevention measures such as hand washing,& sterility
during procedures.
CONT..
Teach the patient use a soft toothbrush to prevent gum mucosal
bleeding.
Protect area of petechiae from further injuries.
Obtain blood samples for Hb level and platelet count daily.
Monitor glucose level daily.
Maintain intake and output charting.
Monitor weight daily..
CONCLUSION
Idiopathic thrombocytopenic purpura is hematological disorder,
characterized by isolated thrombocytopenia without a clinically apparent
cause. The major causes of accelerated platelet consumption include
immune thrombocytopenia, decreased bone marrow production and
increased splenic sequestration.
