Idiopathic thrombocytopenic purpura

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Idiopathic thrombocytopenic purpura
Idiopathic thrombocytopenic purpura (ITP) is the condition of having a 
low platelet count (thrombocytopenia) of no known cause (idiopathic).
[1]
 As most 
causes appear to be related to antibodies against platelets, ITP is also known 
as immune thrombocytopenic purpura or immune-mediated 
thrombocytopenic purpura. Often ITP is asymptomatic, however a very low 
platelet count can lead to visible symptoms, such as purpura (bruises), or more 
seriously, bleeding diathesis.
Epidemiology
A normal platelet count is considered to be in the range of 150,000–450,000 per 
μl (microlitre) or (150–450 x 10
9
/L) of blood for most healthy individuals.  Hence 
one may be considered thrombocytopenic below that range, although the 
threshold for a diagnosis of ITP is not tied to any specific number.
The incidence of ITP is estimated at 50–100 new cases per million per year, with 
children accounting for half of that amount.  At least 70 percent of childhood 
cases will end up in remission within six months, even without treatment.
[2][3][4]
 
Moreover, a third of the remaining chronic cases will usually remit during follow-
up observation, and another third will end up with only mild thrombocytopenia 
(defined as a platelet count above 50,000).
[2]
ITP is usually chronic in adults
[5]
 and the probability of durable remission is 20–40
percent.
[6]
 The male to female ratio in the adult group varies from 1:1.2 to 1.7 in 
most age ranges (childhood cases are roughly equal for both genders) and the 
median age of adults at the diagnosis is 56–60.
[7]
 The ratio between male and 
female adult cases tends to widen with age. In the USA, the adult chronic 
population is thought to be approximately 60,000—with women outnumbering 
men approximately 2 to 1, which has resulted in ITP being designated anorphan 
disease.
[8]
The mortality rate of chronic ITP patients varies but increases as a function of 
age. In a study conducted in Great Britain, it was noted that ITP patients 
experience an approximately 60 percent higher rate of mortality than gender- and
age-matched comparison subjects without ITP. This increased risk of death with 
ITP is largely concentrated in middle-aged and elderly patients. Ninety-six 
percent of reported ITP-related deaths were patients 45 years or older. No 

significant difference was noted in the rate of survival between males and 
females.
[9]
ITP was first described by the German physician Paul Gottlieb Werlhof in 1735,
[10]
 and was originally referred to as Werlhof’s disease.
[11]
 The first report of a 
successful therapy for ITP was in 1916, when a young Polish medical 
student, Paul Kaznelson, described a female patient's response to 
a splenectomy.
[10]
 Splenectomy remained a first-line remedy until the introduction
of steroid therapy in the 1950s. Refractory ITP is a term used in chronic cases 
where thrombocytopenia persists despite the use of all clinically indicated 
therapies.
Signs and symptoms
Petechiae on the lower extremities.
Purpura of the type associated with ITP.
Symptoms of ITP include the development of bruises (purpura) and petechiae, 
especially on theextremities, bleeding from the nostrils, bleeding at the gums, 
and menorrhagia, any of which may occur if the platelet count is below 20,000 
per mm
3
.
[12]
 A very low count (<10,000 per mm
3
) may result in the spontaneous 
formation of hematomas in the mouth or on other mucous membranes. Bleeding 

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Idiopathic thrombocytopenic purpura Idiopathic thrombocytopenic purpura?(ITP) is the condition of having a low?platelet?count?(thrombocytopenia) of no known cause (idiopathic).[1]?As most causes appear to be related to?antibodies?against platelets, ITP is also known as?immune thrombocytopenic purpura?or?immune-mediated thrombocytopenic purpura. Often ITP is?asymptomatic, however a very low platelet count can lead to visible symptoms, such as?purpura?(bruises), or more seriously,?bleeding diathesis. Epidemiology A normal platelet count is considered to be in the range of 150,000-450,000 per ?l (microlitre) or (150-450 x 109/L) of blood for most healthy individuals.? Hence one may be considered thrombocytopenic below that range, although the threshold for a diagnosis of ITP is not tied to any specific number. The incidence of ITP is estimated at 50-100 new cases per million per year, with children accounting for half of that amount.? At least 70 percent of childhood cases will end up in remission within six months, even without treatment.[2][3][4]? Moreover, a third of the remaining chronic cases will usually remit during follow-up observation, and another third will end up with only mild thrombocytopenia (defined as a platelet count above 50,000).[2] ITP is usually chronic in adults[5]?and the probability of?durable remission?is 20-40 percent.[6]? The male to female ratio in the adult group varies from 1:1.2 to 1.7 in most age ranges (childhood cases are roughly equal for bot ...
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