So what are the signs and symptoms of ITP?
This can be a rapid onset, the parents will bring the
child in and say they were totally fine the day before.
Then they'll develop these small red dots on
the skin caused by the broken blood vessels
and these are called petechiae and these can be an areas
of trauma or an areas where they develop spontaneously.
These can coalesce or be bigger and develop purple
spots on the skin and these are called the purpura.
The patient can have bruising on their arms
and legs resulting from seemingly minor bumps
and we'll see kids come into the clinic and they will have
gone to the bus stop in the morning - no marks no bruises
and then they'll get a call from the school nurse,
the parents, well around the afternoon, saying
you know your child looks injured,
you need to come pick them up
and they'll swing them into the clinic that afternoon and we'll assess them
and the child will say they didn't fall
down, they weren't injured at the playground.
This is a spontaneous echymosis,
it can be pretty impressive.
The patient may get frequent or having
nosebleeds and this is called epistaxis.
There may be heavy bleeding during
menstruation, and this is menorrhagia.
There can be bleeding from the gums, gingival bleeding
and we encourage a soft toothbrush in these patients.
There can be blood in the urine called hematuria and
other than that, the other physical exam findings are normal.
In the diagnosis, the normal platelet count on a patient
without ITP is about 150,000 to 450,000 per microliter.
ITP can diagnose, be diagnosed when the
platelet level drops below 100,000 per microliter.
It's a diagnosis of exclusion which means the provider
has excluded all other causes of bruising including cancer.
You'll gather a complete medical history, usually
1-3 weeks prior the child has had a viral illness.
Then you do a full physical exam.
You might do some lab work including a CBC and on the
CBC, the patient will have an isolated thrombocytopenia
which means all other
values on the CBC are normal.
The peripheral smear on
microscopy will also appear normal
and when you do clotting studies on the
clotting times of these, will also be normal.
The patient may get a bone marrow
aspiration and this is to evaluate
the age and the grade of the
platelets in the bone marrow.