Immune thrombocytopenia

Last reviewed: 24 Apr 2022
Last updated: 01 Mar 2019

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • bleeding
  • absence of systemic symptoms
  • absence of medicines that cause thrombocytopenia
  • absent splenomegaly or hepatomegaly
  • absent lymphadenopathy
More key diagnostic factors

Risk factors

  • women of childbearing age
  • age <10 or >65 years
More risk factors

Diagnostic investigations

1st investigations to order

  • FBC and peripheral blood smear
More 1st investigations to order

Investigations to consider

  • HIV serology
  • Helicobacter pylori breath test or stool antigen test
  • hepatitis C serology
  • thyroid function tests
  • quantitative immunoglobulins
  • bone marrow biopsy/aspiration
  • pregnancy test
More investigations to consider

Treatment algorithm

INITIAL

all patients (child or adult): with life- or organ-threatening bleeding

ACUTE

newly diagnosed child

newly diagnosed adult (pregnant or non-pregnant)

ONGOING

child: persistent or chronic disease

adult non-pregnant: persistent or chronic disease

pregnant: persistent or chronic disease

Contributors

Authors

Marie Scully, MD, MRCP, FRCPath

Consultant Haematologist

University College London Hospitals

London

UK

Disclosures

MS has received honoraria from Novartis. MS is the author of a paper cited in this topic.

Acknowledgements

Dr Marie Scully would like to gratefully acknowledge Professor Francesco Rodeghiero and Dr Marco Ruggeri, previous contributors to this topic.

Disclosures

FR received fees for speaking and has been reimbursed by GSK and Amgen, the manufacturer of eltrombopag and romiplostim, for attending several conferences, and also received fees for consulting from GSK and Shionogi. FR and MR are authors of a number of references cited in this topic.

Peer reviewers

Keith McCrae, MD

Professor

Director of Benign Hematology

Cleveland Clinic

Cleveland

OH

Disclosures

KM declares that he has no competing interests.

Sandeep Kumar Rajan, MD

Assistant Professor

Division of Oncology-Hematology

Department of Internal Medicine

University of Nebraska Medical Center

Omaha

NE

Disclosures

SKR declares that he has no competing interests.

  • Differentials

    • Pseudothrombocytopenia
    • Congenital thrombocytopenia
    • Acquired thrombocytopenia (e.g., related to liver disease or alcohol ingestion)
    More Differentials
  • Guidelines

    • 2011 evidence-based practice guideline for immune thrombocytopenia
    • 2011 evidence-based practice guideline for immune thrombocytopenia
    More Guidelines
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