Hematology

Immune Thrombocytopenia (ITP)

Q: Who to treat?

Platelet <20-30 x10^9/L or symptomatic bleeding.

Q: Splenectomy timing?

Deferred >=12 months; use TPO-RA or rituximab first.

Acquired autoimmune thrombocytopenia from anti-platelet antibodies causing isolated low platelets and mucocutaneous bleeding; diagnosis of exclusion.

Last reviewed 30 May 2026 - MedicoMedics editorial team

Pathophysiology

IgG autoantibodies opsonise platelets and megakaryocytes leading to splenic clearance and impaired production; often post-viral in children.

Sources: ASH ITP 2019 (Blood Adv 2019;3:3829); Fostamatinib (Am J Hematol 2018;93:921)

Presentation

Petechiae, purpura, mucosal bleeding (epistaxis, gum), menorrhagia; severe intracranial bleed rare (<1%).

Diagnosis

Isolated thrombocytopenia; normal peripheral smear morphology; exclude drug-induced, TTP, HIV, HCV, H. pylori, lupus. Bone marrow only in atypical adults.

Management

Adults: platelet <30 or bleeding - corticosteroids +/- IVIG; second line: rituximab, TPO-receptor agonists (eltrombopag, romiplostim), fostamatinib, splenectomy. Children usually self-limited.

Sample USMLE-style MCQs

Try 5 questions on this topic. Practice hundreds more free with a trial.

Question 1

A 30-year-old woman has petechiae and platelet 12x10^9/L; other counts normal. Best first therapy?

Question 2

Which drug is a TPO-receptor agonist?

Question 3

Which disease must be excluded before diagnosing ITP?

Question 4

Which infection is commonly associated?

Question 5

Which agent to consider if steroid-dependent and refractory?

References

Primary guidelines and peer-reviewed sources used for this entry. Reviewed 30 May 2026 by MedicoMedics editorial team.

Frequently asked

Who to treat?

Platelet <20-30 x10^9/L or symptomatic bleeding.

Splenectomy timing?

Deferred >=12 months; use TPO-RA or rituximab first.

Chronic ITP?

Persistent >12 months.

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