ITP 

 
often no cause (cause be due to URTI, SLE, HIV, HCV)
  • Acute: children (2-6 y.o) => abrupt hemorrhagic complication following viral illness 
  • Chronic: insidious onset (no disease relation), most often in adults 20-40 (3:1 Female:Male)
IgG antibodies formed against the patient’s platelets
Clinical Presentation
 
  • minor bleeding/ easy bruising 
  • petechiae, hematuria, hematemesis or melena
  • General no splenomegaly 
 
Bloodwork
 
  • Look for increase megakaryocytes due to increase bone marrow production 
  • thrombcytopenia
*diagnosis of exclusion 

Treatment
 
  • Most children will have spontaneous resolution of ITP 
  • Treatment typically reserved for people with symptomatic bleeding 
  • If >20,000 platelets, typically asymptomatic 
  • 1) IVIG (wait 12-24hr and check platelets 2) corticosteroids 3) splenectomy 
 

TTP 

 
Due to lose of ADAMTS13 cleaving vWF => causes formation of platelet microthrombi that occlude small blood vessels, shear RBCS (schistocytes) and causes end organ damage. 
CAUSES: unknown, can be due to infections, bacteria toxins, drug related, autoimmune, or idiopathic 
INCREASED LDH  
BLOOD SMEAR: schistocytes
  • Also known as “helmet cells”
  • fragmented RBC’s due to MAHA (formation of platelet-fibrin mesh due to increased activation of coagulation)
PENTAD
1) Neurological symptoms (delirium, seizure, stroke) 
2) Renal dysfunction (increase Cr)
3) Fever
4) Thrombocytopenia
5) Microangiopathic hemolytic anemia

 

Treatment
  • STEROIDS + PLASMAPHERESIS
  • DO NOT give platelets (contraindicated); it may worsen the condition 
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Dr. C Humphreys

Internal Medicine

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