Immune thrombocytopenic purpura

	Headline
Etiology	isolated thrombocytopenia
Epidemiology
Clinical presentation	bleeding and other mucosal signs of thrombocytopenia
Pathogenesis	antibody destruction of peripheral platelets
Diagnostic investigations	Ddx: DIC, acute leukaemia, HUS (AKI) FBC (expect only one cell line to be affected)
Management	- Steroids - raises platelet count over 2-14 days - Platelets only for signfiicant bleeding - Repeat FBC in 7 days + paeds OPD r/v - Oral TXA for mucosal bleeding

Severity

Severity	Signs
Mild	Few petechiae and small (<5cm) bruises. Epistaxis stopped by applied pressure within 20 minutes.
Moderate	Numerous petechiae and large (>5cm) bruises. Epistaxis longer than 20 minutes. Intermittent bleeding from gums, lips, buccal, oropharynx, or gastrointestinal (GI) tract. Hypermenorrhagia, haematemesis, macroscopic haematuria, melaena - without hypotension and falling Hb <20 g/L.
Severe	Epistaxis requiring nasal packing or cautery. Continuous bleeding from gums, buccal, oropharynx. Suspected internal haemorrhage (lung, muscle, joint). Hypermenorrhagia, haematemesis, macroscopic haematuria, melaena - without hypotension and falling Hb >20 g/L.
Life-threatening	Intracranial Haemorrhage (ICH) or: Continuous or high-volume bleeding resulting in hypotension or prolonged capillary refill and requiring fluid resuscitation or blood transfusion.