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Immune thrombocytopenia

Last reviewed: 3 Nov 2023
Last updated: 01 Mar 2019



History and exam

Key diagnostic factors

  • bleeding
  • absence of systemic symptoms
  • absence of medications 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

  • CBC 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 immune globulins
  • bone marrow biopsy/aspiration
  • pregnancy test
More investigations to consider

Treatment algorithm


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


newly diagnosed child

newly diagnosed adult (pregnant or nonpregnant):


child: persistent or chronic disease

adult nonpregnant: persistent or chronic disease

pregnant: persistent or chronic disease



Marie Scully, MD, MRCP, FRCPath

Consultant Haematologist

University College London Hospitals




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


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


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


Director of Benign Hematology

Cleveland Clinic




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




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
  • Videos

    Venepuncture and phlebotomy: animated demonstration

    Peripheral venous cannulation: animated demonstration

    More videos
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