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Review
. 2022 Jan 29:14:25-34.
doi: 10.2147/OAEM.S331675. eCollection 2022.

Assessment and Management of Immune Thrombocytopenia (ITP) in the Emergency Department: Current Perspectives

Tony Zitek  1   2 , Luke Weber  1 , Dominique Pinzon  1 , Nicole Warren  1   2   3
Affiliations
Review

Assessment and Management of Immune Thrombocytopenia (ITP) in the Emergency Department: Current Perspectives

Tony Zitek et al. Open Access Emerg Med. .

Abstract

Immune thrombocytopenia (ITP) is characterized by a platelet count less than 100 × 10^9/L without anemia or leukopenia. Patients with ITP may be asymptomatic, or they may have mild bleeding like petechiae, purpura, or epistaxis. In rare cases, they may present to the emergency department (ED) with life-threatening bleeding as a result of their thrombocytopenia. The emergency physician should thus be prepared to diagnose ITP and treat the bleeding that can result from it. The diagnosis of ITP requires excluding secondary causes of thrombocytopenia, and in the ED, the bare minimum workup for ITP includes a complete blood count and a peripheral blood smear. The peripheral blood smear should show a small number of large platelets with normal morphology, and there should not be an increased number of schistocytes. Many patients with ITP require no emergent treatment. However, if a patient with suspected ITP presents to the ED with critical hemorrhage, the emergency physician should initiate treatment with a platelet transfusion, corticosteroids, and intravenous immune globulin (IVIG) as soon as possible. For less severe bleeding, platelet transfusions are not recommended, and the treatment consists of corticosteroids by themselves or in conjunction with IVIG.

Keywords: ITP; diagnosis; symptoms; treatment.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
(A) Example of cutaneous purpura. (B) Example of oral (“wet”) purpura.
See this image and copyright information in PMC

References

    1. McCrae K. Immune thrombocytopenia: no longer ‘idiopathic’. Cleve Clin J Med. 2011;78(6):358–373. doi: 10.3949/ccjm.78gr.10005 - DOI - PMC - PubMed
    1. Nuent D, McMillan R, Nichol JL, Slichter SJ. Pathogenesis of chronic immune thrombocytopenia: increased platelet destruction and/or decreased platelet production. Br J Haematol. 2009;146(6):585. doi: 10.1111/j.1365-2141.2009.07717.x - DOI - PubMed
    1. Toltl LJ, Arnold DM. Pathophysiology and management of chronic immune thrombocytopenia: focusing on what matters. Br J Haematol. 2011;152(1):52. doi: 10.1111/j.1365-2141.2010.08412.x - DOI - PMC - PubMed
    1. Onisâi M, Vlădăreanu A-M, Spînu A, Găman M, Bumbea H. Idiopathic thrombocytopenic purpura (ITP) – new era for an old disease. Rom J Intern Med. 2019;57(4):273–283. - PubMed
    1. Rodeghiero F, Stasi R, Gernsheimer T, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009;113(11):2386. doi: 10.1182/blood-2008-07-162503 - DOI - PubMed