Tasty Morsels of EM 048 – ITP

30 Apr

As always, this is from the ever expanding google doc on bits and bobs I read and learn from and transfer here for all our learning pleasure. This one from a recent training day in one of the Dublin children’s hospitals.

  • relatively common, most often in kids 2-6
  • usually without splenomegaly
  • as usual with something with “idiopathic” in the name it is a diagnosis of exclusion
  • very rarely involves serious bleeding despite platelets commonly <20
  • 90% rate of spontaneous remission. Steroids are commonly given but perhaps not always needed given the low mortality (<1%) and good rate of spontaneous improvement.
  • outbreaks in spring and autumn associated with URTIs implying an autoimmune cause
  • vast majority can be discharged (with follow up of course, usually recheck blood count in a week or so). Note Rosen’s suggests initial admission but my own experience and that of the paeds haematologist speaking to us was that admission achieved little.
  • head bleeds
    • a big deal if they happen
    • give lots of platelets (more than usual) as the platelets you transfuse will disappear in the same way that the patient’s platelets have already disappeared
    • definite indication for steroids and some IVIG

References:

  • Lecture by paeds haematologist, Dublin 2015 (high quality referencing there…)
  • Rosen’s 8th ch 122, p 1611

Image credit:

Wikipedia, CC License

One Reply to “Tasty Morsels of EM 048 – ITP”

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