Immature Platelet Frustration

Emergencies happen in hematology and oncology. This is a fact. But how do we manage these emergencies? Look no further. In this episode, we talk all about our first hematologic emergency: immune thrombocytopenic purpura (ITP).

Immune thrombocytopenic purpura (ITP):

Be sure to check out episode 009 on thrombocytopenia for a general approach and differential!

Specific instances where there may be close to undetectable platelet count:

* Lab artifact (clumping)

* Very severe DIC

* Thrombotic thrombocytopenic purpura - though usually higher platelets in these cases

* Heparin induced thrombocytopenia (in very severe cases) - though usually higher platelets in these cases

* ITP

ITP: Diagnosis of exclusion

How to confirm it is ITP?

* Post-transfusion CBC - a repeat CBC 30-60 mins after a platelet transfusion. In ITP, the platelet count will likely not budge. (Not perfect test!)

* Immature platelet fraction (if available) - this will be elevated if mature platelets are being destroyed. (Again - not a perfect test)

Treatment in acute cases:

IVIG 1g/kg daily x2 days + Dexamethasone 40mg daily x4 days

Reference:

https://ashpublications.org/blood/article/106/7/2244/21649/How-I-treat-idiopathic-thrombocytopenic-purpura - Great How I Treat article from Blood

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