A 36-Year-Old Man Who Bruises Easily: Osmosis USMLE Study Question

March 08, 2019

Answer: C. No active treatment

Idiopathic thrombocytopenic purpura (ITP), also known as primary immune thrombocytopenic purpura and autoimmune thrombocytopenic purpura, is defined as isolated thrombocytopenia with normal bone marrow and the absence of other causes of thrombocytopenia. In adults with ITP, the onset tends to be insidious, and clinical symptoms include epistaxis, gingival bleeding, petechiae, and easy bruising. Isolated thrombocytopenia on a complete blood cell count is the key laboratory finding. Other cell lines are typically normal with normal coagulation studies. The blood smear shows the absence of normal platelets with one young large platelet in the middle of the view. This is commonly seen in response to the autoimmune peripheral destruction of platelets that occurs in ITP.

Adults with platelet counts greater than 50,000/mm3 generally do not require treatment. Treatment is indicated for adults with significant mucous membrane bleeding and for individuals with a platelet count less than 20,000-30,000/mm3 due to the risk of internal bleeding. Treatment is also indicated for those adults with risk factors for bleeding, like hypertension and peptic ulcer disease. Glucocorticoids and IVIG are first-line options for ITP. Individuals may require splenectomy or the use of thrombopoietin receptor agonists in refractory cases.

Major Takeaway: Treatment for ITP is primarily dictated by symptoms and signs. In general, no treatment is required for adults with platelet counts greater than 50,000/mm3. In individuals that require treatment, glucocorticoids and IVIG are first-line therapies.

Read more about ITP.


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