What are the clinical findings for Immune Thrombocytopenic Purpura (ITP)?

From the Guidelines

Immune thrombocytopenia (ITP) is characterized by a platelet count below 100,000/μL, often presenting with mucocutaneous bleeding manifestations, including petechiae, purpura, and ecchymoses, as well as mucosal bleeding such as epistaxis, gingival bleeding, menorrhagia, and gastrointestinal bleeding 1. The clinical findings for ITP typically include isolated thrombocytopenia with normal red and white blood cell counts and morphology, and a peripheral blood smear that confirms true thrombocytopenia without platelet clumping, showing normal-sized platelets. Some key points to consider in the clinical findings of ITP include:

• Mucocutaneous bleeding manifestations, such as petechiae, purpura, and ecchymoses, particularly on the lower extremities
• Mucosal bleeding, including epistaxis, gingival bleeding, menorrhagia, and gastrointestinal bleeding
• Severe cases may present with intracranial hemorrhage, though this is rare (less than 1% of cases)
• Physical examination usually reveals only bleeding manifestations without hepatosplenomegaly or lymphadenopathy
• Laboratory findings show isolated thrombocytopenia with normal red and white blood cell counts and morphology
• Bone marrow examination, when performed, reveals normal or increased megakaryocytes without abnormalities in other cell lines, as noted in the american society of hematology 2011 evidence-based practice guideline for immune thrombocytopenia 1. ITP is essentially a diagnosis of exclusion, requiring elimination of other causes of thrombocytopenia such as medications, infections, or other autoimmune conditions, with the absence of systemic symptoms and isolated thrombocytopenia being key distinguishing features of primary ITP.

From the Research

Clinical Findings for ITP

The clinical findings for Immune Thrombocytopenic Purpura (ITP) can be summarized as follows:

• ITP is characterized by isolated thrombocytopenia without a clinically apparent cause 2, 3
• The major causes of accelerated platelet consumption include immune thrombocytopenia, decreased bone marrow production, and increased splenic sequestration 2
• Clinical presentation may be acute with severe bleeding, or insidious with slow development with mild or no symptoms 2
• Initial laboratory tests useful at the first visit to predict future diagnosis include erythrocyte count, leukocyte count, anti-glycoprotein IIb/IIIa antibodies, reticulated platelets, and plasma thrombopoietin level 2
• Certain factors, such as a low platelet count, history of bleeding, and certain comorbidities can increase the risk of severe bleeding in patients with ITP 4

Diagnosis and Treatment

• Diagnosis of ITP is one of exclusion, and a thorough and timely workup of thrombocytopenia is imperative to rule out other differentials of ITP 5, 3
• Treatment should be restricted to those patients with moderate or severe thrombocytopenia who are bleeding or at risk of bleeding 5, 2
• The standard initial treatment for ITP is oral corticosteroids to increase platelet counts, and other treatments such as intravenous immunoglobulin, anti-D immunoglobulin, and splenectomy may also be used 5
• Recent advances in the management of ITP include the use of thrombopoietin receptor agonists, rituximab, and other novel therapeutic targets 4