immune thrombocytopenic purpura


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id·i·o·path·ic throm·bo·cy·to·pe·nic pur·pu·ra (ITP),

a systemic illness characterized by extensive ecchymoses and hemorrhages from mucous membranes and very low platelet counts; resulting from platelet destruction by macrophages due to an antiplatelet factor; childhood cases are usually brief and rarely present with intracranial hemorrhages, but adult cases are often recurrent and have a higher incidence of grave bleeding, especially intracranial.

immune thrombocytopenic purpura

[-sī′təpē′nik]
Etymology: Gk, thrombos + kytos, cell, penia, poverty; L, purpura, purple
mucocutaneous bleeding of thrombocytopenia, caused by a platelet membrane-specific autoantibody that shortens the platelet lifespan. It is diagnosed by exclusion of drug effects, inflammatory disorder, thrombotic thrombocytopenic purpura, DIC, or hematologic disorder. It affects middle-aged adults and is more prevalent in women than in men. Acute immune thrombocytopenic purpura is a side effect of viral infection in children 2 to 6 years of age, and although the thrombocytopenia is profound, the disorder resolves spontaneously within a few weeks. Also known as autoimmune thrombocytopenic purpura, once called idiopathic thrombocytopenic purpura. Compare disseminated intravascular coagulation. See also hemophilia, hemorrhagic diathesis, thrombasthenia.
observations Common manifestations include petechiae and ecchymoses on the skin, particularly the lower extremities; easy bruising; bleeding from the nose and gums; melena in stools; hematemesis; heavy menses and breakthrough bleeding; and hematuria. Jaundice, fever, and decreased levels of consciousness may be seen in thrombotic thrombocytopenic purpura. Diagnosis focuses on obtaining a history of bleeding symptoms and on ruling out other causes of thrombocytopenia, such as medications, ethanol abuse, HIV, or hematologic disorder. Lab findings include decreased platelet count. Bleeding time is prolonged, but coagulation time is normal. Capillary fragility is increased. Bone marrow aspiration shows an abundance of megakaryocytes. In thrombotic thrombocytopenic purpura there is severe anemia, elevated BUN, elevated creatinine, elevated reticulocytes, elevated LDH, decreased haptoglobin, and fragmented RBCs on peripheral smear. Platelet size and morphological appearance may be abnormal in thrombotic thrombocytopenic purpura. Complications include hemorrhage into organs, such as the brain, gastrointestinal tract, or heart, which can be fatal without treatment.
interventions Medications that may be causing or contributing to the thrombocytopenia are discontinued. Treatment is determined by platelet count and bleeding status. Corticosteroids are used to enhance platelet production and promote capillary integrity. Immunosuppressants are used if the disease does not respond to steroids. Platelet transfusions are used in cases of severe bleeding in idiopathic thrombocytopenic purpura. Plasma exchange or plasmapheresis is the treatment of choice in thrombotic thrombocytopenic purpura. VinCRIStine may be used in thrombotic thrombocytopenic purpura cases that are refractory to plasmapheresis. Splenectomy may be considered for severe unresponsive thrombocytopenia. Immune globulin is given to prepare severely thrombocytic individuals for surgery. Platelet counts and bleeding episodes are monitored closely. Stool softeners are administered to prevent constipation.
nursing considerations Nursing goals are aimed at eliminating gross or occult bleeding, maintaining vascular integrity, decreasing risk for injury, and reducing complications. Safety precautions are instituted to prevent bruising (e.g., mouth swabs and soft bristle toothbrush for oral care; electric razor for shaving; insertion of IV access device for blood draws; padding bed rails and hard surfaces). Emesis, sputum, stool, urine, and other secretions for occult blood and pad counts during menstruation are frequently assessed and tested. Active bleeding is controlled with ice packs, gentle pressure, or packing. Rest and activity should be carefully balanced to conserve energy. Education is necessary about trauma prevention and safety precautions; avoidance of contact sports; avoidance of the Valsalva maneuver; the necessity for gentle coughing, sneezing, and nose blowing; and the necessity for increased fluid intake and balanced periods of rest and exercise. Instruction is given in infection precautions for those taking immunosuppressants. Education includes instruction to avoid anticoagulant over-the-counter medications, such as aspirin/aspirin products and other NSAIDs.

immune thrombocytopenic purpura (ITP)

abnormally low platelet count associated with mucocutaneous bleeding. Acute ITP is a disease of children that may follow a viral infection, lasts a few weeks to a few months, and usually has no residual effects. Chronic ITP appears in adolescents and adults, especially women of childbearing age, with insidious onset, and is usually lifelong. Autoantibodies to platelets are found in patients with ITP. The condition may be transmitted to the fetus if the mother is affected. Treatment includes corticosteroids, therapeutic plasmapheresis, and splenectomy. See also thrombocytopenia, thrombocytopenic purpura.

immune thrombocytopenic purpura

Idiopathic thrombocytopenic purpura, see there.

id·i·o·path·ic throm·bo·cy·to·pe·nic pur·pu·ra

(ITP) (id'ē-ō-path'ik throm'bō-sī-tō-pē'nik pŭr'pyŭr-ă)
A systemic illness characterized by extensive ecchymoses and hemorrhages from mucous membranes and very low platelet counts; resulting from destruction in the spleen of platelets to which an autoimmune globulin is bound; childhood cases, which often follow viral infection, are mild and transitory; in adults, bleeding may be recurrent and severe.
Synonym(s): immune thrombocytopenic purpura, purpura hemorrhagica, thrombopenic purpura.
References in periodicals archive ?
Prospective evaluation of the immunobead assay for the diagnosis of adult chronic immune thrombocytopenic purpura (ITP).
anti-D increases the platelet count more rapidly and for a longer period of time than dose 50 microg/kg/d in adults with immune thrombocytopenic purpura (Br J Haematol 2001; 112:1076-1078.
Therapy for adults with refractory chronic immune thrombocytopenic purpura.
The pathophysiology of ITP revisited: ineffective thrombopoiesis and the emerging role of thrombopoietin receptor agonists in the management of chronic immune thrombocytopenic purpura.
Mabthera (Rituximab) in the treatment of 92 patients with refractory immune thrombocytopenic purpura.
octagam([R])10% is a liquid, 10% (100 mg/mL) immune globulin (human) solution for intravenous administration (IVIG) which is currently registered mainly in European countries, where it is indicated for the use in: primary humoral immunodeficiency (PI); myeloma or chronic lymphatic leukaemia with severe secondary hypogammaglobulinaemia and recurrent infections; in children with congenital AIDS who have repeated bacterial infections; immune thrombocytopenic purpura (ITP) in children or adults at high risk of bleeding or prior to surgery to correct the platelet count; Guillain Barre syndrome; Kawasaki disease.
IMMUNE THROMBOCYTOPENIC PURPURA (ITP), the most common autoimmune disorder, results from accelerated platelet destruction after the binding of autoreactive antibodies to platelets.
Our aim was to present a rare case of immune thrombocytopenic purpura (ITP) following paclitaxel treatment.
Immune thrombocytopenic purpura (ITP) is an autoimmune disease characterized by antibody-mediated platelet destruction.
R&D projects of syk kinase inhibitors to treat rheumatoid arthritis, immune thrombocytopenic purpura (ITP), asthma, allergic rhinitis and B-cell lymphoma are discussed as of February 2008.
These efforts include commencing a Phase 3 clinical study of fostamatinib, an oral SYK inhibitor, in Immune Thrombocytopenic Purpura (ITP) pending discussions with regulatory agencies.

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