Immune Thrombocytopenic PurpuraUrgent

Petechiae, bruising, gum bleeding; platelets 8×10⁹/L with normal Hb and WBC; otherwise well

• Headache, vomiting or drowsiness (intracranial bleed)
• Wet purpura / mucosal blood blisters
• Haematuria, melaena or menorrhagia with Hb fall
• Platelets <10×10⁹/L

• EDTA pseudothrombocytopenia
• TTP/HUS (schistocytes)
• Drug-induced (heparin, quinine, valproate, linezolid)
• Dengue, HIV, HCV
• Aplastic anaemia, leukaemia, MDS
• Cirrhosis with hypersplenism

• Admit: New diagnosis with platelets <20×10⁹/L, mucosal (wet) bleeding, poor access to follow-up
• ICU: Intracranial or life-threatening haemorrhage
• Transfuse: Platelets only with life-threatening bleeding or before emergency surgery, together with IVIG/steroids

• ITP is a diagnosis of exclusion: isolated thrombocytopenia with a normal film — schistocytes, blasts or abnormal white cells mean it is not ITP.
• The aim is a safe count (≥30×10⁹/L without bleeding), not a normal one.
• Test and eradicate H. pylori; treat HIV/HCV if found — both can raise the count.
• Pregnancy: prednisolone or IVIG; aim ≥50×10⁹/L for delivery and ≥75–80×10⁹/L for neuraxial anaesthesia.

• Transfuse platelets for a number alone — they are destroyed within hours
• Give IM injections, NSAIDs or aspirin while platelets are low
• Continue steroids beyond 6–8 weeks to hold a count
• Treat asymptomatic adults with platelets ≥30×10⁹/L

• Not looking at the film
• Platelet transfusion without bleeding
• Long steroid courses
• Missing secondary causes (HIV, HCV, SLE, CLL, drugs)

Ward while platelets are <20×10⁹/L or bleeding; haematology clinic weekly until stable.