Idiopathic Purpura

Idiopathic purpura

This is the most common cause of acquired thrombocytopenia child. There is a peak incidence around 5 years. The cause is unknown but some viral etiologies are sometimes suspected: rubella, measles, chickenpox, infectious mononucleosis, cytomegalovirus, hepatitis B, HIV. Sometimes it is found in the days preceding a febrile episode of non-specific type of viral ENT. The onset is usually acute with multiple bruises, nosebleeds, petechiae, purpura, blood in urine, bleeding gums, blood in stool ... Serious bleeding are possible if platelets are below 10 000/mm3. The fundus (FP) is necessary to search for bleeding into the retina. The cerebral haemorrhage is a major risk.

Idiopathic purpura diagnosis includes:

Complete study of blood coagulation;
Group rhesus and irregular antibodies;
Determination of immunoglobulins;
Blood culture;
Myelogram only in cases of suspected hematologic malignancies. Required if a corticosteroid is provided;

Idiopathic purpura pictures

Idiopathic purpura treatment

The evolution is unpredictable. Thrombocytopenia may heal within a month within three months or take years ... Relapses are possible, sometimes promoted by a viral infection or vaccination.

A case of purpura with a low number of platelets need a spinal myelogram. It is based on immunoglobulin infusion in a day or two consecutive days by the response. Tolerance is good (side effects: chills, fever, general malaise). This treatment does not cure ITP but definitely shortens the period of bleeding and shorten hospitalization. Recurrence is possible 3 weeks later (time of removal of immunoglobulins). Platelet transfusions are not indicated in the PTI except in cases of visceral bleeding.The evolution toward chronic ITP (beyond 6 months / 1 year) is rare: 10% of cases. In this case treatment in a specialized unit called immunoglobulins, corticosteroids, interferon alpha. In some cases prolonged isotopic exploration is conducted to discuss the value of a splenectomy (removal of the spleen) in children over 5 years. Splenectomy is very effective, but after the intervention, one must avoid superinfections with resistant pneumococci. The pneumococcal vaccine is important.