Idiopathic Thrombocytopenic Purpura (ITP) its causes,clinical picture,diagnosis and newest treatment

Acute - children (post infection)

- autoimmune disorder 

- antiplatelet antibodies (IgG against       platelet glycoproteins)

- IgG coated platelets removed by     spleen ( platelet survival)

Usually  megakaryocytes in BM

Clinical Picture

· The classic presentation of ITP is at age 1-4 years.

· Sudden onset of generalized petechial purpura in a previously healthy child.
· Intracranial hemorrhage
· no organomegally
· 70-80%  spontaneous recovery.  
· About 10-20% develop chronic ITP persisting more than 6 months.
Laboratory investigations:
 
· Platelet count is reduced below 150x109 /L, bleeding occurs with platelet count<40 x109/L. 
· Bleeding time and clot retraction test yield abnormal results. 
· Anemia is not present unless significant blood loss has occurred. 
· White blood cell count is normal. 
· Bone marrow aspiration reveals normal granulocytic and erythrocytic series, normal or increased numbers of megakaryocytes, some of megakaryocytes are immature, platelet budding may be scanty but there is no diagnostic megakaryocyte morphology.     
D.D:

Non thrompocytopenic purpura:

Other thrompocytopenic purpura:

l          Aplastic anemia

l          Bone marrow infiltration

l          hypersplenism

•           Treatment
Fresh blood

•          PLT transfusion

•          IV immunoglobulin

•          Steroid therapy

•          IV antiD therapy

•          splenectomy