Idiopathic thrombocytopenic purpura

The finding of thrombocytopenia with normal or increased megakaryocytes on bone marrow aspirate supports the diagnosis of ITP. It is essential, however, that every effort be made to exclude other causes of the consumption of platelets. Most cases of chronic ITP are immune in origin; consequently, steroid therapy is the initial treatment of choice, followed by splenectomy if indicated. Twenty-five per cent of patients fail to respond to either treatment modality; however, bleeding manifestations are often mild even when a response in the platelet count is not achieved. Although acute ITP is often self-limiting, exacerbations and remissions may occur in both acute and chronic types of ITP.