Immune Thrombocytopenia (ITP): Fundamentals (Pediatric Nursing)

00:01 Now let's cover idiopathic thrombocytopenia purpura or ITP.

00:06 ITP is a platelet disorder that occurs in people who have an abnormally low number of platelets in the blood.

00:12 This is idiopathic, that means we don't know the cause.

00:16 Thrombocytopenia which is the decreased number of platelets, And puprura, that's the discoloration of the skin - it's purple, looks like a bruise.

00:24 In the United States, approximately 4 to 8 children per 100,000 under the age of 15 will have one of the two forms of ITP.

00:32 "Purpura" is a word of Latin origin meaning purple and it denotes reddish purple lesions.

00:37 that are greater than 2 mm in size caused by bleeding under the skin.

00:41 Here in the right, you'll see some petechiae and those are smaller pinpoint hemorrhages, those are usually less than 2 mm in size.

00:48 So this was first recognised by the ancient Greeks and Romans, Hippocrates and Galen ITP has acquired many different names throughout history and through the study and understanding of the disease process.

00:59 There are two types, the first is acute, this is the most common form.

01:03 We see this in pediatrics usually ages 2 to 6.

01:07 This is usually after a viral illness and it has a sudden onset.

01:11 It's gonna resolve in less than 6 months and usually goes away within a few weeks.

01:16 It usually does not recur in these patients, it's a one-time isolated incident.

01:22 That's in contrast to chronic ITP and this is less common, this can happen at any age but it's more common in adults.

01:29 It's gonna last for greater than 6 months and that's what makes it chronic.

01:33 It's more common in females and it's going to recur and require management by a specialist - a hematologist.

01:40 So let's compare and contrast here.

01:42 In acute ITP, the peak incidence we service between 2 and 6 years old so we think of pediatrics.

01:49 It's not preferred male or female, there's no sex predilection.

01:53 And the antecedent infection is usually viral.

01:56 These kids will usually have a virus or a cold 1 to 3 weeks before this begins.

02:00 The onset of bleeding can be abrupt and the platelet count is really low, it's less than 20,000 per microliter.

02:08 The eosinophils and the lymphocytes in the white blood cells can be elevated and this is common, this is eosinophilia and lymphocytosis.

02:16 The duration, remember it lasts about 2 to 6 weeks, it rarely last longer but it can last a few months.

02:21 And it will go away spontaneously about 80% of the time.

02:26 That's in contrast to chronic ITP, remember this is the adult population, 20 to 40 year olds.

02:31 It's more common in females than males, there's usually no antecedent infection and it's insidious which means it's not an abrupt bleeding, it's a slow steady decline in the platelets.

02:44 The platelet counts are gonna drop to between 30,000 and 80,000 and we rarely see changes with the eosinophils and the lymphocytes.

02:51 This can last for months or years because remember it's a chronic condition and it usually does not have spontaneous remission.

03:00 It is idiopathic in the absence of other causes of thrombocytopenia such as medications, infections, malignancies or other autoimmune disorders.

03:09 If you can explain by one of these causes why your patient has thrombocytopenia, than they don't have ITP.

03:16 So we said most cases are unknown, it's important to know this is not contagious, you're not gonna spread this to another patient.

03:23 And a common cause that we talked about as a post-viral setting usually three weeks after a viral illness.

03:29 So remember in the pediatric population, it's benign and self limiting and it's rare.

03:34 We see this in 4 to 8 per 100,000 children per year.

03:39 Often a child will have a virus about 3 weeks before developing ITP, this is the classic story While making antibodies against their viral infection, the body can also accidentally make antibodies that are gonna stick to the platelets.

03:52 The body's gonna recognize these, mistakingly thinking that they'r foreign cells and will begin to destroy them.

03:59 The bone marrow at the center of the long bones is responsible for making the blood cells including the platelets.

04:05 the bone marrow's gonna respond to the low number of platelets by trying to churn out even more platelets.

04:10 This is gonna result in an increased number of young platelets in circulation.

04:15 A normal healthy platelet will live 7 to 10 days but in the setting of ITP, they will only live for a few hours.

04:24 The rate of destruction is gonna exceed the rate of production and adequate number of useful platelets are not available to form a blood clot.

04:32 So we see two processes going on in ITP.

04:35 The first is we have increased platelet destruction.

04:38 These antibodies again are gonna tag and mark the platelets and that's gonna cause the cells of the immune system to attack and destroy them.

04:45 The second process that's going on is the body's not able to make enough platelets to make up for those being destroyed.

04:53 ITP is gonna result in the increased platelet destruction and the impaired platelet production.

04:58 Here we see the normal blood vessel up top, the patient has a normal amount of red blood cells and a normal amount of platelets.

05:05 Down in the setting of ITP, the patient's red blood cells are normal but they have a decreased amount of platelets.