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Idiopathic Thrombocytopenic Purpura : Definition, Causes, Symptoms, Sign, Diagnosis and Treatment

Tuesday, August 21st 2012. | Blood Health, Disease

Idiopathic Thrombocytopenic Purpura Definition

Idiopathic thrombocytopenic purpura (ITP) is characterized by a decrease in blood platelets.

The diagnosis of this disease acquired isolated is worn only after eliminating all other possible causes of thrombocytopenia. ITP is considered a benign disease : the risk of bleeding is high mainly when the platelet count is collapsed (rare situation).

The presence on the skin of small hemorrhagic spots purple, non-erasable by pressure, corresponds to the existence of a petechial purpura. It is a spontaneous passage of the red blood cells out of the blood vessels under the skin and mucous membranes. A biological assessment is useful for understanding the origin of the disorder that can be associated with thrombocytopenia (decreased number of platelets in the blood), a platelet malfunction or excessive vascular fragility.

Idiopathic thrombocytopenic purpura (ITP) is characterized by a decrease in blood platelets. Its occurrence is related to the production of autoantibodies by a cell clone directed against the complex and GPIIbIIIa GPIbIX present on platelets.

The diagnosis of this disease acquired isolated is worn only after eliminating all other possible causes of thrombocytopenia, including medication (or toxic), chronic alcoholism, recent infection. Are distinguished in both acute and chronic forms.

Idiopathic Thrombocytopenic Purpura

Idiopathic Thrombocytopenic Purpura (img thanks to childrenshospital.org)

Idiopathic Thrombocytopenic Purpura Ris Factor

The young subjects with a disease of the blood cells are at risk

ITP affects preferentially young subjects (including children under the age of 10 years) and women more often than men.

It can be discovered incidentally during a blood test standard in a balance sheet for autoimmune disease (rheumatoid arthritis, Crohn’s disease, …) or in the management of hemorrhagic manifestation.

Note that it is the elderly with hematologic malignancies (CLL, myelofibrosis, aplastic anemia), patients with vasculitis (Henoch-Schonlein purpura, sarcoidosis, cirrhosis, PR) and patients treated for cirrhosis or renal failure who are at risk of have purpura.

Idiopathic Thrombocytopenic Purpura Sign

Bleeding at the center of symptoms.

Unexplained bleeding episode, the appearance of a petechial purpura (“red spots” on the skin of onset), various bleeding (nose, mouth or unexpected rules), bruising are signs unjustified suggestive of thrombocytopenia (platelets or fall). 

More rarely, the occurrence of subarachnoid hemorrhage or bleeding of the retina (“red-eye”) incentives to seek emergency thrombocytopenia.

Idiopathic Thrombocytopenic Purpura Diagnosis

Examinations and blood clotting allow diagnosis.

ITP is a diagnosis of exclusion, a series of tests are therefore necessary to confirm that the disease is no known cause.

These tests will be done according to the clinical context (children, elderly, suspected autoimmune diseases, …): a platelet count in the blood, bone marrow (analysis of marrow cells) and an assessment of hemostasis (time bleeding) are three tests that can determine the causes of purpura.

The biological analysis laboratory may indicate that smear is observed absence of platelet aggregates, an absence of abnormalities in other blood cell lineages and the hemostasis balance shows a lengthening of bleeding time.

The bone marrow, when performed, shows marrow megakaryocytes rich with an absence of other cell lines.

The test MAIPA (Platelet Antigen Monoclonal Antibody Immobilized) specifies the specificity of self-directed against platelet Ag are most often located on the complex GPIIbIIIa or GPIbIX.

Idiopathic Thrombocytopenic Purpura Treatment

ITP is considered a benign

ITP can presetner high risk of bleeding especially when the platelet count is collapsed (rare situation). The severity of the disease depends on the size of the hemorrhagic syndrome, its location.

Nearly 80% of PTI child heal spontaneously, without any need for treatment (with acute ITP). When the hemorrhagic syndrome is important or the platelet count is very low (less than 30 g / L), it is then discussed prescribing corticosteroids, immunoglobulins, or other medications (anti-D Ig G, Danazol , immunosuppressants). Platelet transfusions are rare and reserved for massive bleeding.

For rare forms of chronic ITP, usually removal of the spleen (splenectomy) can correct thrombocytopenia.

Idiopathic Thrombocytopenic Purpura Consultation

The appearance of purpura justifies a consultation to determine its cause.

To guide the physician’s diagnosis, it is important to clarify the circumstances of its appearance infection, taking medications, monitoring for disease (hematologic malignancy, autoimmune disease, etc …). Bringing your latest blood tests, the doctor may examine whether blood abnormalities existed before and then guide the application of blood coagulation and the balance sheet.

For monitoring purpura, it is important to note the presence or absence of hemorrhagic manifestations (nosebleeds, bruising, …) and to present recent blood tests in order to monitor the platelet count.

In rare cases of ITP requiring therapeutic treatment, it is best to avoid self-medication and seek medical advice regarding precautions to take with a specific treatment (corticosteroids, immunoglobulins, ..,)

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