Episode 015: Heme/Onc Emergencies, Pt. 4: Immune thrombocytopenic purpura

Emergencies happen in hematology and oncology. This is a fact. But how do we manage these emergencies? Look no further.

In this episode, we talk all about our first hematologic emergency: immune thrombocytopenic purpura (ITP)

---

Immune thrombocytopenic purpura (ITP):

• Be sure to check out episode 009 on thrombocytopenia for a general approach and differential!

• Specific instances where there may be close to undetectable platelet count:

  • Lab artifact (clumping)

  • Very severe DIC

  • Thrombotic thrombocytopenic purpura - though usually higher platelets in these cases

  • Heparin induced thrombocytopenia (in very severe cases) - though usually higher platelets in these cases

  • ITP

• ITP:

  • Diagnosis of exclusion

    • How to confirm it is ITP?

      • Post-transfusion CBC - a repeat CBC 30-60 mins after a platelet transfusion. In ITP, the platelet count will likely not budge. (Not perfect test!)

    • Immature platelet fraction (if available) - this will be elevated if mature platelets are being destroyed. (Again - not a perfect test)

  • Treatment:

    • IVIG 1g/kg daily x2 days + Dexamethasone 40mg daily x4 days

Reference:

https://ashpublications.org/blood/article/106/7/2244/21649/How-I-treat-idiopathic-thrombocytopenic-purpura - Great How I Treat article from Blood

---