REFERAT

DIAGNOSIS DAN TATALAKSANA

IDIOPATHIC THROMBOCYTOPENIC
PURPURA (ITP)

What is ITP
Immune / idiophatic thrombocytopenic
purpura (ITP) is a bleeding disorder in which
the blood doesnt clot as it should, this is due
to the deficient of blood cell fragments called
platelet or thrombocytes

 Platelets are small blood cells that alias functions

as blood clotting factors
Platelets have an important function in
preventing and stopping bleeding.
Normal number of platelets in the body is from
150,000 to 400,000 / cubic mm. Loss or damage
to one of the blood cells that cause
thrombocytopenia will cause noise in the system
due to platelet hemostasis with vascular system
and blood coagulation factors simultaneously
involved in maintaining normal hemostasis

What are the types of ITP ?

1. Acute ITP
generally lasts less than 6 month. It mainly
occurs in children, both boy and girls,
and idiophatic TP is the most common type of
TP it often occurs after an infection from virus
2. Chroic TP lasts around 6 month or more than 6
month . It mainly in adults. Women are 2-3
times more likely to be affected by chronic TP

Acute ITP

Chronic ITP

age

A peak incidence between 2-5

years of age

20 -50 years of age

Female over male , 3:1

onset

Relatively acute

Relatively chronic

Degree of hemorrhage

Relatively acute

Relatively mind

Course of desease

6 months

Months to years

Platelet count

Mostly, < 20,000/ mcL

Commonly 30,00080,000/mcL

Number of megakaryocytes of
bonemarrow

Normal or increased

Increased markedly

Manifestations
Bleeding
(most important clinical manifestation of ITP
petechiae
ecchymoses
epistaxis (spontaneous bleeding from nose)
gingival bleeding
menorrhagia
Disabling fatigue
Proteinuria/ hematuria
Abdomonal pain
nausea, vomiting
fever

Diagnostic tests

Laboratory
o Platelets (often <20000-30000 / MCL) and normal blood cells.
o Bleeding Time (BT, Bleeding Time) prolong

o The period of prothrombin (PT, Prothrombin Time): normal

o Partial Prothrombin Time (PTT, Partial PT): normal

o Examination of peripheral blood deletion:

- Leukocytes, hemoglobin in normal circumstances unless there
is bleeding.
- Platelets greater (younger), there is no collection of platelets
o marrow examination:
- Result: normal or increased megakaryocytes in acute ITP

 The bone marrow in patient with ITP contains normal or increase

number of megacaryocytes

Commond medications used to treat

idiopathic thrombocytopenic purpura
Corticosteroid
the first line of therapy is acorticosteroid, usually
PREDNISON which can help raise your platelel count by
decreasing the activity of your immune system.
once your platelet counts is back to a safe level, you can
gradually discontinue taking the drug under the direction of
your doctor. In general, this takes about two to six weeks
Dose : oral tablets 0,1 -2mg/kg/day in devided
doses 1 to 4 times/day
IV IM 0,1 2mg/kg/day in devided doses
1 to 4 times/day

 Intravenous immue globulin (IVIG)

dose intravenous immunoglobulin 1mg/kg/day
for <5000/ml
2-3 days in a row is used when there is iternal
bleeding (platelets
If you have critical bleeding or need to quickly
increase your blood count before surgery, you
may receive medications such as immune
globulin given inravenously.these medications are
quick and effective

 High dose steroids

therapy ITP patiets can be used in additional
prednison to DEXAMETHASONE oral higedose
40mg/day repeated every 28days for 6 cycles
high dose METYLPREDNISOLONE can given to
childre and adults with ITP resistant to dose
prednison therapy

 Anti D iv
the doseof anti D 50-75mg/kb/day
mechanisme of action of anti-D is the
destruction of red bloods cells of rhesus Dpositive that specifically grated in the spleen