Immune thrombocytopenia

Case history

A 50-year-old woman presents approximately 3 weeks after an upper respiratory tract illness with petechiae, easy bruising, and gum bleeding. She has no personal or family history of a bleeding disorder and takes no medicines. Physical examination is normal except for petechiae and bruising. Specifically, she has no lymphadenopathy or hepatosplenomegaly. Full blood count reveals thrombocytopenia with a platelet count of 12 × 10⁹/L (12 × 10³/microlitre) but other cell lines are within normal limits. Peripheral blood smear shows thrombocytopenia but no other abnormalities.

Other presentations

In about half of adult cases, thrombocytopenia may be an incidental finding on routine full blood count or during investigation for another illness. Patients may have no bleeding symptoms or signs.

Rarely patients can present with organ- or life-threatening major bleeds and require emergency treatment.

Children typically present with sudden onset of mucocutaneous bleeding with extensive bruising and petechiae.