New Fellow Bootcamp Series: ITP

An exciting new academic year is about to begin. We know this can be daunting, especially for our newest hematology/oncology fellows. Over the next two weeks, we re-boot some of our high yield episodes you need to know to prepare for your first days as a new fellow and your nights on call.

Next up: immune thrombocytopenic purpura [Originally episode 015]

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Be sure to check out our Rotation Guides to get you in tip-top shape for fellowship!

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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

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