Management Of Immune Thrombocytopenic Purpura Research Articles

Utility of Immature Platelet Fraction as Diagnostic Biomarker for Isolated Thrombocytopenia

Objective: To evaluate the utility of immature platelet fraction (IPF) as a marker in immune thrombocytopenia purpura (ITP) patients. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Haematology, Chughtai Institute of Pathology, Lahore Pakistan, from Aug to Nov 2020. Methodology: Sixty patients (Group-1) of immune thrombocytopenia purpura were selected. Sixty healthy individuals (Group-2) with normal blood count parameters were also included. A complete blood count with simultaneous evaluation of immature platelet fraction was performed for both groups on 3ml peripheral blood collected in K2EDTA. To check the reproducibility of results, each sample was run in duplicate. Results: Group-1 had a mean platelet count of 43.77±32.82 x109 /L (range 2-98x109/L), a mean immature platelet fraction of 12.93±6.11% (range 3–25%) and a mean age 36.68±7.53 years, (range 22–56 years). Group-2 had a mean platelet count of 251.7±83.55 x109 /L (range 150-450 x109 /L), a mean immature platelet fraction of 3.78±1.86 %, (range 1-7.2%) and a mean age of 36.42±6.94 years, (range 22–55 years). ROC curve analysis yielded an immature platelet fraction value of 7.0% as the cut-off between immune thrombocytopenic purpura patients and healthy individuals. Conclusion: Immature platelet fraction, though novel, is a useful marker to diagnose and monitor treatment response, diagnosis and management of immune thrombocytopenic purpura.

Ayurvedic management of immune thrombocytopenic purpura - a case report

Immune thrombocytopenic purpura (ITP) is a bleeding disorder characterized by isolated thrombocytopenia. The course is more chronic in adults associated with higher mortality in older patients. In extreme cases of ITP, serious complications such as bleeding into the lungs, brain, or other vital organs can occur. Clinical manifestations include purpura, petechiae and ecchymosis. Majority of ITP patients are not getting reliable and durable remissions with modern medicine. The present case report deals with an elderly patient having chronic ITP with multiple comorbidities (obesity, schizophrenia, UTI and T2DM) approached for Ayurvedic treatment. Patient came with ecchymotic patches on both upper extremities with extremely low platelet counts (9700/mcL) was diagnosed as Tiryaggata Raktapitta and Ayurvedic treatment has been provided. Ayurvedic formulations (Putapakwa Vishama Jwarantaka Loha, Raktastambhaka Vati, Samshamani Vati etc) have improved the platelet counts (from the lowest count of 9700/mcL to highest count of 50000/mcL), hematological indices and quality of life in present case. Ecchymotic patches were completely disappeared without any further recurrences. The present case of ITP (Raktapitta) is a good example for Nidaanaarthakara Roga as it has manifested due to the consequences of malarial fever (Vishama Jwara). Ayurvedic treatment seems to be promising in the management of chronic ITP and generates hope for those patients who are having extreme thrombocytopenia, multiple comorbidities, reluctant (or unfit) for corticosteroids and invasive diagnostic procedures like bone marrow biopsy, and not satisfied with the available therapy from other systems of medicine. Further clinical trials with large sample size are required to substantiate the present case study findings.

Immune Thrombocytopenic Purpura and Paradoxical Thrombosis: A Systematic Review of Case Reports.

Immune thrombocytopenic purpura (ITP) is an acquired bleeding disorder characterized by autoantibodies against platelets. The clinical presentation is variable; the main symptom is bleeding, and many patients are asymptomatic; others have nonspecific symptoms like fatigue. Uncommonly, ITP can present with paradoxical thrombosis. The risk of thrombosis in ITP may be higher than expected, which makes the management of ITP more challenging. This review aims toevaluate patients with ITP who develop thrombosis and identify potential risk factors related to thrombosis in this category of patients. English literature was searched using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for adults above 18 years with primary ITP who had infarctions or thrombotic events. PatientswithsecondaryITP were excluded. The search included articles published up to 20th October 2021. A total of73 articles were included. Seventy-seven patients with ITP had developed infarctions and various thrombotic events.Sixty-three patients had arterialevents, and 14 patients developed venous thrombotic events. Patients with ITP have low platelets, which predispose them to bleed; despite that, serious thrombotic complications can happen in these patients and are difficult to predict. Therefore, it is critical for physicians to understand that ITP is paradoxically a prothrombotic condition and to address preventive thromboembolic measures whenever possible.

The Use of Clinical Scores in the Management of Immune Thrombocytopenic Purpura in Children.

While the majority of children with recently diagnosed ITP have a benign, self-limiting condition, most often with a spontaneously recovery, 40% of children with ITP progress toward persistent ITP and 10–20% goes toward chronicity. Several clinical scores have been developed with the aim to perform a better monitoring outcome or to differentiate transient vs. persistent ITP (e.g., Donato score). Our paper aims to describe and to compare the most important scores used in the management of ITP in children: bleeding severity scores and chronicity prediction scores. These scores include a combination of different already known risk factors: age, gender, presence of a previous infections or vaccination, bleeding grade, type of onset, platelet count at diagnosis. The real utility of these scores has been a matter of debate and no consensus has been reached so far as to their necessity to be implemented as compulsory tool in the care of children with ITP.

A case study on Ayurvedic management of Immune Thrombocytopenic Purpura w.s.r to Tiryaka Raktapitta

Immune Thrombocytopenic Purpura is an autoimmune disorder which is characterized by destruction and decrease in the number of platelets count due to the presence of autoantibodies directed against platelet. There are two types of Idiopathic thrombocytopenic purpura i.e. acute and chronic forms which are characterized by mucocutaneous bleeding such as oral mucosa, heavy menstrual bleeding or gastrointestinal bleeding and low platelet count with normal peripheral blood cells and smear. Clinical features of ITP are ecchymosis and petechiae or thrombocytopenia incidentally found on a routine CBC. Bleeding disorders are explained in classics under the heading of Raktapitta. ITP can be correlated with Tiryaka Raktapitta as in this disorder. It is tridoshaja vayadhi and its manifestation will be subcutaneous bleeding. In this study, a 45 years old female patient had complaints of bleeding from gums and heavy menstrual bleeding for 4 years was treated with Guduchi Kwatha and Aamlaki churna, Shatavari churna, Vata churna, Nimba Arka, fresh Papaya patra swarasa for 6 months. Significant improvement was observed in patient condition and blood reports and platelet count is stable without any allopathic medications.

An Unusual Cause of Secondary ITP in a 34-Year-Old Hispanic Male

Secondary immune thrombocytopenic purpura (ITP) associated with Helicobacter pylori (H. pylori) infection has been described in the literature. It appears to have a geographic distribution; mostly encountered in countries with a higher prevalence for H. pylori such as Italy or Japan. H. pylori eradication has been recommended in the management of ITP with studies showing improvement in the platelet count in some patients. Substantial platelet count increases in patients with severe thrombocytopenia (platelet counts <30 × 103 microliter), however, are uncommon with H. pylori treatment alone. Here, we present a 34-year-old Hispanic male with worsening chronic thrombocytopenia that resolved following eradication of his H. pylori infection. Herein, we highlight a rare and reversible cause of secondary ITP. With this case report, we hope to encourage physicians to include H. pylori testing in the evaluation of thrombocytopenia.

Practical considerations for the management ofimmune thrombocytopenic purpura.

Immune thrombocytopenic purpura (ITP) is a rare hematological disorder with an autoimmune-mediated, often dramatic reduction of platelets in peripheral blood. Thrombocytopenia results from a reduced life span of thrombocytes and an additionally decreased production in bone marrow. For decades, the first-line therapy for ITP has been corticosteroids. As significant thrombocytopenic bleedings occur, the use of additional medication may be needed. Recent updates on therapy guidelines recommend the shortest possible use of corticosteroids. Thrombopoietin-receptor agonists are often used second line. Today splenectomy, which was previously recommended after unsuccessful first-line therapy, is usually considered much later. Patients who do not respond even after multiple lines of therapy continue to pose a major challenge. New drugs for ITP treatment are now available after steroid failure and will be discussed. This review gives a short summary on actual therapy guidelines taking into account newly available therapy options. In addition, comparisons between selected published data and experience at our department are made.

A real-world study of immune thrombocytopenia management during the COVID-19 pandemic in the UK.

SummaryThe COVID‐19 pandemic has created many challenges in the management of immune thrombocytopenic purpura (ITP). The recommendation for avoidance of steroids by WHO led to the off‐licence use, supported by NHS England, of thrombopoietin mimetics (TPO‐RA) for newly diagnosed or relapsed ITP. This is a real‐world prospective study which investigated the treatment patterns and outcomes in this setting. Twenty‐four hospitals across the UK submitted 343 cases. Corticosteroids remain the mainstay of ITP treatment, but TPO‐RAs were more effective. Incidental COVID‐19 infection was identified in a significant number of patients (9·5%), while 14 cases were thought to be secondary to COVID‐19 vaccination.

Fatigue and cognitive impairment in immune thrombocytopenic purpura remain stable over time: short report from a longitudinal study.

Immune thrombocytopenic purpura (ITP) is an autoimmune disorder characterised by low platelet counts and increased bleeding risk. In 2009, two cross-sectional studies determined that fatigue and cognitive impairment (CI) were common in ITP. Here, we report the results from a longitudinal study of 34 people with ITP. Fatigue severity remained unchanged over 7years, and CI significantly improved. Future fatigue and CI severity could be predicted using baseline severity scores. These findings may be reassuring for ITP patients, as symptoms remain stable over time. Furthermore, using baseline scores to predict future severity could aid the clinical management of ITP.

Immune Thrombocytopenic Purpura in Pregnancy- A Prospective Observational Study in a Tertiary Care Centre

Objectives: Immune thrombocytopenic purpura (ITP) in pregnancy necessitates management of two patients, the mother and the newborn. Complications like maternal bleeding, fetal and neonatal thrombocytopenia demands appropriate and timely therapy. This prospective observational study was designed to explore and summarize the current approach to the investigation, diagnosis, management and outcome of ITP in pregnancy. Materials and Methods: Women with ITP admitted in the Fetomaternal Medicine Department of Bangabandhu Sheikh Mujib Medical University (BSMMU) from 2009 -2017, were included in the study. Total number of high risk pregnancy during that period were 7704 among them 20 cases were pregnancy with Immune Thrombocytopenic Purpura (ITP). Patients were managed under joint supervision of the fetomaternal medicine specialist and the hematologist. Prednisolone was considered as a first line drug in management protocol. Platelet transfusion was considered if there were symptoms or count &lt;20X109/L at any stage of pregnancy or &lt;50 X109 / L in late pregnancy without symptoms. Platelet count of newborn was performed at birth and repeated on day four and count&lt;150X109/L was considered as neonatal thrombocytopenia. Results: Frequency of ITP among high risk patients was found 2.5/1000 live birth, most were preexisting (75%). Almost all cases (95%) were treated with prednisolone. Commonest clinical presentations were gum bleeding (70 %) and purpuric rashes (60%). Though during pregnancy, severe thrombocytopenia (&lt;50 X109/L) was found in 7 patients (35%) but none was at the time of delivery, as drugs and/or platelet transfusion was considered to make delivery process safe. Platelet transfusion needed in 77.7% cases in a range of 1-75 units. Primary PPH noted in 3 cases (17%), increased bleeding during surgery in 5 patients (33%) and one patient needed ICU support. Neonatal thrombocytopenia noted in 5 cases (28%). Though 2 of the neonates needed NICU admission but none needed platelet transfusion and all the babies were discharged healthy. Conclusion: This study documents that pregnancy with ITP need close monitoring, require agents to raise the platelet count and repeated platelet transfusion to maintain reasonable safe platelet count. There are chances of PPH, capillary oozing during surgery. However good outcome is possible for most women, fetus and neonates with appropriate and timely therapy. Bangladesh J Obstet Gynaecol, 2019; Vol. 34(1): 15-21

Management of Immune thrombocytopenic purpura during pregnancy: A single center experience

Background: Immune thrombocytopenic Purpura (ITP) is the second most common cause of an isolated low platelet count during pregnancy. It account for about 3% of thrombocytopenic cases during delivery. Treatment is indicated, if there is an evidence of bleeding or platelet count is less than 30,000/µl. Herein, we presented a medical record of twenty-four pregnant women, who were diagnosed with ITP during pregnancy.&#x0D; Method: A total number of twenty four pregnant women diagnosed with primary ITP and having platelet count of less than 30000/µl were enrolled in the study. Oral prednisolone (1mg/kg) was started in all patients with an aim to keep the platelet count above 50000/µl during delivery. Steroid was continued for 21 consecutive days and were tapered (10 mg) every week, if platelet counts were above 30000/µl.&#x0D; Data pertaining to the ITP during pregnancy was recorded for age, platelet count, mode of delivery and complications related to steroid therapy and were analyzed by simple statistical analysis.&#x0D; Result: ITP was observed in about 58%, 25% and 17% of the cases during first, second and third trimester respectively. About, 63% of patients presented with purpuric rash, 18% presented with mucosal bleed, one present presented with hematuria and others were asymptomatic. More than two third of cases responded to the steroid and in those cases platelet counts were above 50,000/µl at the time of delivery. All subjects delivered a healthy child. There was no maternal mortality and post-partum hemorrhage was absent in all patients.&#x0D; Conclusion: Steroid is the treatment of choice for all cases of ITP. ITP is no longer a contraindication to the continuation of pregnancy, the tradition and tendency to advice for abortion in these pregnant mothers, may not be justifiable.

Clinical Course of Primary Immune Thrombocytopenia with Positive Antiphospholipid Antibodies

Introduction: Antiphospholipid (aPL) antibodies are commonly detected in patients with primary immune thrombocytopenic purpura (ITP) and whether the presence of these antibodies affect the prognosis of the disease is not known yet. Nevertheless, knowledge on the role of aPL in primary ITP would contribute to the management of the disease.Aim: Our primary aim was to evaluate if aPL antibodies are associated with either persistence or chronic primary ITP. We also aimed to evaluate the association of aPL antibodies with platelet counts and any bleeding event during the follow-up.Methods: This is a retrospective cohort study that took place in the Hematology Center of the University of Campinas. We collected data on patients with primary ITP diagnosed between January 2008 and January 2016. Lupus anticoagulant (LAC), IgG/IgM anticardiolipin and antibeta2glycoprotein1 (aB2GP1) assays were performed at diagnosis, and repeated within 12 weeks when positive. We compared the baseline characteristics of patients with and without aPL using chi-square test, when variables were categorical, or independent t-test when variables were continuous. We used logistic regression and linear regression to examine the association between aPL and binary and continuous outcomes respectively. Cox regression was used to evaluate the cumulative risk of bleeding. Analysis were adjusted for age and sex.Results: One hundred ninety-six patients were included and the median follow up time was 41 months. Forty-nine patients (21%) were positive for aPL (29 LAC, 20 aB2GP-1, 25 anticardiolipin IgM ou IgG, and 4 triple-positive). Baseline characteristics were similar between groups. Positivity for aPL was not associated with the risk of either persistent (OR=1,5 95%CI= 0.8; 3.0) or chronic ITP (OR=1,2 95%CI= 0.6;2.4). Mean platelet counts at 3 months was 123 x 103 (SD 111 x 103) U/mL in aPL negative patients and 103 x 103 (SD 117 x 103) U/mL in aPL positive patients (mean difference -18 x103 [95%CI= -55 to 18 x103]). Mean platelet counts at 12 months was 127 x 103 U/mL in aPL negative patients and 117 x 103 U/mL in aPL positive patients (mean difference -10 x103 [95%CI= -50 to 29 x103]). aPL positivity was not associated with bleeding events (HR= 1.3 95%CI=0.9; 1.8).Conclusion: Our results demonstrated that the presence of aPL does not influence the clinical course of primary ITP. This suggests that the investigation of aPL may not be useful for the management of primary ITP. [Display omitted] DisclosuresDe Paula:Hematology and Transfusion Medicine Center, University of Campinas: Employment.

Rituximab - A novel therapy for severe ITP in pregnancy: A case report.

Rituximab is a novel second-line agent for the treatment of immune thrombocytopenic purpura. Minimal data exist on the use of rituximab in pregnancy. This case illustrates the successful treatment of severe immune thrombocytopenic purpura diagnosed in pregnancy, refractory to all other medical management. A 32-year-old nulliparous woman was diagnosed with severe immune thrombocytopenic purpura at the time of booking for antenatal care (platelet level of 13 × 109/L). Standard treatment failed to adequately increase her platelet count. Therapy with rituximab was instituted, and her platelet count rose to normal levels, without side effects, and remained at a normal level throughout the pregnancy. There were no maternal or neonatal ill-effects of rituximab therapy. Rituximab is potentially a safe treatment option for the management of immune thrombocytopenic purpura in pregnancy with good maternal and neonatal outcome when conventional treatments have been unsuccessful. Research is limited to case reports, and therefore limited information currently exists to guide clinicians.

Lessons in the diagnosis and management of immune thrombocytopenic purpura in children.

Lessons in the diagnosis and management of immune thrombocytopenic purpura in children.

Clinical feature and management of immune thrombocytopenic purpura in a tertiary hospital in Northwest Nigeria.

Background:Immune thrombocytopenic purpura (ITP) is a rare bleeding disorder that may remit spontaneously. Life-threatening bleeding may require transfusion support, steroids, and other immunosuppressive therapy or splenectomy.Objective:To review the clinical presentation and laboratory features of ITP at Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria.Subjects and Methods:A retrospective analytic study of case notes and bone marrow (BM) records of patients diagnosed with ITP at Haematology Department, ABUTH, Zaria, from January 1, 2004, to December 31, 2012.Results:There were nine cases (six females, three males), aged 6–20 (mean 11.11) years. The presentations were epistaxis 8 (88.9%), purpura 4 (44.4%), gum bleeding 4 (44.4%), menorrhagia 2 (22.2%), and intracranial hemorrhage (ICH) 1 (11.1%). Only 1 (11.1%) had clinical splenomegaly. Platelet count of <20 × 109/L was found in 4 (44.4%) while 6 (66.7%) had packed cell volume of <25%. All the nine cases had BM megakaryocytic hyperplasia. Six patients had blood transfusion support while 7 (77.8%) patients received oral prednisolone therapy with time to cessation of bleeding of 12–16 (mean of 8) weeks. One case had spontaneous remission while another had anti-D due to relapse after steroid therapy; this resulted in transient rise in platelet counts. None had other immunosuppressive therapy or splenectomy. Six (66.7%) cases were lost to follow-up after achieving remission and one died of ICH.Conclusion:ITP is not common in our center though its clinical presentations are varied. However, prednisolone and blood transfusion therapy are central to the management of these patients with favorable outcome.

Factors associated with the effect of open splenectomy for immune thrombocytopenic purpura.

To assess the effect and complications of open splenectomy (OS) for immune thrombocytopenic purpura (ITP) and determine preoperative factors associated with surgical effect. This was a retrospective analysis of ITP patients who failed medical therapy and were treated with OS between 1997 and 2014 at the Jinshan Hospital, China. Follow-up was 60 months. Surgical effect was determined from platelet counts and bleeding episodes. Complications were assessed including bleeding episodes. Preoperative factors were identified by logistic regression analysis. Fifty-six patients (48.2 ± 16.2 yr old; 39 females) were included. Disease course was 31.2 ± 48.2 months; 91.1% patients had preoperative platelet count <20 × 109 /L. OS effect at 1 wk, 1 month, 1 yr, and 5 yrs was in 91.1%, 92.9%, 91.1%, and 89.3% patients, respectively. Pneumonia or lower extremity thrombosis occurred in 7.1% patients. Postoperative mild, moderate, and severe bleeding occurred in 33.9%, 50.0%, and 16.1% patients, respectively. No patients required blood transfusion. Mortality was zero. Larger spleen size associated with surgical effect at 1 wk, 1 month, and 1 yr, and lower preoperative minimum platelet count associated with effect at 5 yrs (P < 0.05). Open splenectomy is an effective treatment with less complications for the management of ITP. Lower preoperative minimum platelet count associated with successful OS at 5 yrs.

An update on the management of immune thrombocytopenic purpura and emerging treatment options: A review and case report

Immune thrombocytopenic purpura affects both children and adults. It is an autoimmune disorder characterised by persistent thrombocytopenia (peripheral platelet count of less than 150 x10 9 /L) due to autoantibody binding to platelet antigen(s) causing their premature destruction by the reticulo-endothelial system, in particular the spleen. There is no gold standard diagnostic test to confirm ITP. The diagnosis of ITP remains clinical and is based principally on the exclusion of other causes of thrombocytopenia by the history, physical examination, full blood count, peripheral blood film and autoimmune screen. Medical options for front-line drug therapy are corticosteroids, intravenous immunoglobulin, and intravenous Rh anti-D. Second and third line therapy includes monoclonal antibodies and thrombopoirtin receptor agonist. Transfusion of platelet is warranted if life threatening hemorrhage occurs. This review gives a brief discussion on the pathophysiology, clinical presentation, diagnosis and treatment of Immune Thrombocutopenic Purpura and a case report.

Effect of Carica Papaya leaf Extract on Platelet Count in Chronic Immune Thrombocytopenic Purpura: A Case Series

Background:The leaves of Carica papaya have been used to treat thrombocytopenia in the critical phase of Dengue fever in areas where the virus is endemic. This case series describes the use of C. papaya leaf liquid extract (CPLE) as an adjunctive therapy for four patients receiving standard-of-care treatment for chronic immune thrombocytopenic purpura (ITP).Case 1:A 67 yo M diagnosed with ITP in 1999 presented on 8/17/2013 with bruising and a platelet count of 5 x 103/ml. No response was seen to prednisone 125 mg QD. He subsequently received a course of IV Ig and IV methylprednisolone sodium succinate, but platelet count remained under 5 x 103/ml on 9/13/13. He was prescribed CPLE 3,000 mg QD on 9/30/13. Platelets increased to 148 x 103/ml by 10/8/13 and remained elevated above 250 x 103/ml for five months.Case 2:A 21 yo F diagnosed with ITP in 2011 underwent splenectomy on 11/7/13. Despite this intervention, platelet count decreased to 95 x 103/ml on 4/22/14. She was prescribed CPLE 3,000 mg QD as a monotherapy and by 5/8/14, platelet count increased to 156 x 103/ml. CPLE was discontinued and platelet count remained in normal range at 146 x 103/ml on 5/15/14.Case 3:A 56 yo M diagnosed with ITP in 2011 was referred for splenectomy on 9/19/12 after his platelet count dropped below 40 x 103/ml despite corticosteroid therapy. Prior to surgery, on 9/30/12, he initiated CPLE 3,000 mg QD in addition to prednisone 10 mg QD. On 11/7/12, pre-surgical labs revealed a platelet count of 115 x 103/ml and splenectomy was cancelled due to adequate platelet count. Platelets remained elevated over threshold for surgery for over four months.Case 4:A 60 yo F diagnosed with ITP in 1992 was referred for splenectomy and refused the procedure on 6/5/13. The patient's platelet count was 86 x 103/ml while on prednisone 10 mg QD and she was prescribed CPLE 3,000 mg QD. Her platelet count increased to 109 x 103/ml on 5/12/13 but subsequently dropped to 98 x 103/ml on 5/20/13. CPLE was discontinued at this time due to lack of beneficial action on platelet count.Conclusion:CPLE may prove beneficial in the management of refractory ITP for patients interested in alternative therapy before progressing to second-line treatments. Based on the association observed in these cases, a larger clinical trial is warranted to evaluate CPLE as an adjunctive therapy in chronic ITP. DisclosuresNo relevant conflicts of interest to declare.

The management of immune thrombocytopenic purpura.

Thrombocytopenia, defined as a platelet count less than 100 × 109/L, is common in clinical practice and poses diagnostic and management difficulties. Haemostasis involves a delicate balance between procoagulant and anticoagulant mechanisms. The major components of haemostasis are platelets, coagulation factors, coagulation inhibitors, fibrinolysis and blood vessels.1 In severe thrombocytopenia, this haemostatic balance may be disturbed, leading to bleeding. Bleeding caused by thrombocytopenia is mucocutaneous and can present in different forms, which may include epistaxis, menorrhagia, petechiae, ecchymosis, subconjuctival haemorrhage and oozing of blood from surgical incision sites. Qualitative platelet disorders can also cause mucocutaneous bleeding. These qualitative platelet disorders can be hereditary or acquired. Acquired causes include uraemia in chronic renal disease and the antiplatelet action of drugs, such as aspirin.2 The pattern of bleeding caused by coagulation disorders is quite different from that caused by platelet abnormalities. Bleeding resulting from coagulation disorders is characterised by bleeding into the joints, muscles, and connective tissue.1 Definitive diagnosis of qualitative platelet dysfunction cannot be made in Malawi; in our context, especially, the importance of a good clinical history cannot be overstated. Quantitative platelet disorders can be easily diagnosed from a full blood count that reveals thrombocytopenia. One cause of thrombocytopenia is immune thrombocytopenic purpura (ITP), and this will be the topic of discussion in this scholarly corner paper.

Platelet Disorders

A bleeding disorder may be suspected when a patient reports spontaneous or excessive bleeding or bruising, often secondary to trauma. Possible causes can vary between abnormal platelet number or function, abnormal vascular integrity, coagulation defects, fibrinolysis, or a combination thereof. This review addresses hemorrhagic disorders associated with quantitative or qualitative platelet abnormalities, such as thrombocytopenia, platelet function disorders, thrombocytosis and thrombocythemia, and vascular purpuras. Hemorrhagic dis­orders associated with abnormalities in coagulation (e.g., von Willebrand disease and hemophilia) are not covered. An algorithm shows evidence-based practice guidelines for the management of immune thrombocytopenic purpura. Tables list questions regarding bleeding and bruising to ask patients, clinical manifestations of hemorrhagic disorders, typical results of tests for hemostatic function in bleeding disorders, causes of thrombocytopenia, other forms of drug-induced thrombocytopenia, classification of platelet function disorders, and selected platelet-modifying agents. This review contains ­1 highly rendered figure, 7 tables, and 82 references.