2. Platelet Count And Consideration
• 1,50,000-4,50,000 – Normal
• Less than 1,50,000 platelets/μL is thrombocytopenia
• 20,000 to 50,000 platelets/μL can aggravate posttraumatic bleeding
• less than 20,000 platelets/μL may be associated with spontaneous
4. Approach to thrombocytopenia
-Is the patient bleeding?
-Do the sites of bleeding suggest a platelet defect?
- Duration - Is thrombocytopenia acute or chronic ?
- Is there a history of medications, alcohol use, or recent transfusion (postn transfusion
- Are there any symptoms of a secondary illness?
-(neoplasm, infection, autoimmune disease)
-Is there a family history of thrmobocytopenia ?
-Heparin exposure - recent or within past three months (HIT)?
- Are there any risk factors for HIV infection?
-History of liver disease?
6. Immune Thrombocytopenic Purpura
Immune (idiopathic) thrombocytopenic purpura (ITP) is thrombocytopenia
(platelets <1,50,000/mm³) due to an auto- immune disorder which occurs due
to presence of autoantibodies directed against platelet membrane
glycoproteins mainly GPIIb/Illa and GPIB/IX.
Since every patient may not have purpura, the term ITP is redefined as
8. Types Of ITP
1. Acute (<6months)
Most frequent in children (2-6 years) ,affects both sexes equally
Commonly follows an antecedent upper respiratory viral infection
Usually a self-limiting disease .Abrupt onset of haemorrhage into skin and
mucous membranes-e.g. purpura, petechiae, ecchymoses, epistaxis, bleeding
from oral cavity, gastrointestinal and genitourinary tracts
Intracranial haemorrhage occurs rarely.
9. Signs and Symptoms
Bleeding signs and symptoms
Intracranial hemorrhage (rare)
10. 2. Chronic(>6 months)
Most frequent in adults (20-40 years)
Females affected more than males (M:F ratio, 1:3)
Usually no preceding history of viral infection
Usually a chronic disease characterised by remissions and relapses Insidious onset of
haemorrhage into skin and mucous membranes-e.g. purpura, petechiae, ecchymoses, epistaxis
and menorrhagia.ti Purpurae are more common in the distal parts of limbs.
11. Bleeding signs and symptoms
Excessive bleeding with minor injuries
Spontaneous bleeding from the mouth and nose
Unexplainable or spontaneous bruising
Excessive internal bleeding
Disturbed sleep cycle/ Insomnia
14. Diagnostic Test
Bleeding time: prolonged
CBC: low number of platelets
Platelet associated Antibody may be detected
Bone Marrow Examination: shows megakaryocytic hyperplasia