Idiopathic Thrombocytopenic Purpura

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Idiopathic Thrombocytopenic Purpura

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Idiopathic thrombocytopenic purpura is a condition that is characterized by abnormally low levels of platelets in the blood stream. Platelets are cells that help the blood to clot, so this problem may then lead to the ease of or excessive bleeding and/or bruising.

The normal amount of platelets in the blood stream is between 150,000 to 400,000 cells per microliter of blood. Patients diagnosed with idiopathic thrombocytopenic purpura have platelet counts of less than 20,000 cells, and sometimes even less than 10,000. This makes internal bleeding a very likely situation, even without injury.

The condition is also referred to as immune thrombocytopenic purpura if the cause of the condition is due to an autoimmune reaction.


Idiopathic thrombocytopenic purpura affects both adults and children, and the causes of the condition between these two demographic groups differ.


In some affected individuals, idiopathic thrombocytopenic purpura is caused by an autoimmune reaction where proteins, produced by the immune system of the body, attack the platelets. These antibodies then attach to the platelets, and since the spleen recognizes these proteins as foreign, removes them and therefore decreases the platelet level in the blood stream.

Idiopathic thrombocytopenic purpura in children is usually a complication of viral infections such as the flu, measles or mumps. It’s thought that the infective process triggers the mentioned autoimmune reaction to occur.

Signs and symptoms

Idiopathic thrombocytopenic purpura may produce no symptoms, but the following are issues that may be experienced by some with this condition:

  • Easy to develop or increased bruising (purpura).
  • Bleeding from the gums, mouth or nose.
  • An abnormally heavy menstrual flow.
  • Blood present in the stool or urine.
  • Superficial bleeds under the surface of the skin, called petechiae, that appear as small point shaped red/purple spots. This usually occurs on the lower legs.


Idiopathic thrombocytopenic purpura is suspected on the medical history of the patient and the clinical findings made on examination.

The diagnosis of the condition will be confirmed after other reasons for a decreased platelet count have been excluded by performing various blood tests and investigations. These include a complete blood count (CBC) to monitor the level of the platelets, a peripheral blood smear to confirm the number of platelets, and a bone marrow biopsy to help determine the cause of the condition. The latter test is not routinely performed in children with idiopathic thrombocytopenic purpura since we know the origin of the condition in this demographic.


Children with idiopathic thrombocytopenic purpura tend to recover from this condition once their viral infection resolves. Therefore, nothing more than monitoring of their platelet counts and symptomatic management of the infection is required here.

Adults who are diagnosed with idiopathic thrombocytopenic purpura tend to develop a chronic problem which may become severe. Management options here will include using medications to help suppress the immune system, such as prednisone, so that the autoimmune reaction towards the platelets is reduced, or surgically removing the spleen (splenectomy).

If oral steroids don’t work, then intravenous immunoglobulin (IVIG) may need to be administered. Medications that stimulate the bone marrow to produce platelets may also need to be given.

Patients may also be advised to discontinue medications and natural products that inhibit the clotting action of platelets such as aspirin, warfarin, ibuprofen and ginkgo biloba.

If idiopathic thrombocytopenic purpura results in life-threatening levels of platelets, immediate medical attention is required. This will involve administering a platelet transfusion, intravenous steroids and IVIG.

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