Open Access Emergency Medicine (Jan 2022)
Assessment and Management of Immune Thrombocytopenia (ITP) in the Emergency Department: Current Perspectives
Abstract
Tony Zitek,1,2 Luke Weber,1 Dominique Pinzon,1 Nicole Warren1– 3 1Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA; 2Department of Emergency Medicine, Herbert Wertheim College of Medicine at Florida International University, Miami, FL, USA; 3Department of Medical Education, University of Miami School of Medicine, Miami, FL, USACorrespondence: Tony ZitekMount Sinai Medical Center, Department of Emergency Medicine, 4300 Alton Road, Miami Beach, FL, 33140, USA, Tel +1 305-674-2121 x56632, Email [email protected]: Immune thrombocytopenia (ITP) is characterized by a platelet count less than 100 × 10^9/L without anemia or leukopenia. Patients with ITP may be asymptomatic, or they may have mild bleeding like petechiae, purpura, or epistaxis. In rare cases, they may present to the emergency department (ED) with life-threatening bleeding as a result of their thrombocytopenia. The emergency physician should thus be prepared to diagnose ITP and treat the bleeding that can result from it. The diagnosis of ITP requires excluding secondary causes of thrombocytopenia, and in the ED, the bare minimum workup for ITP includes a complete blood count and a peripheral blood smear. The peripheral blood smear should show a small number of large platelets with normal morphology, and there should not be an increased number of schistocytes. Many patients with ITP require no emergent treatment. However, if a patient with suspected ITP presents to the ED with critical hemorrhage, the emergency physician should initiate treatment with a platelet transfusion, corticosteroids, and intravenous immune globulin (IVIG) as soon as possible. For less severe bleeding, platelet transfusions are not recommended, and the treatment consists of corticosteroids by themselves or in conjunction with IVIG.Keywords: ITP, symptoms, diagnosis, treatment
