Immune thrombocytopenic purpura

Immune thrombocytopenic purpura
Diagnosis in short
Synonyms	immune thrombocytopenia, idiopathic thrombocytopenic purpura
LM	germinal centres in white pulp (~55% of cases), neutrophils in the red pulp (~67% of cases), macrophages in the red pulp
Subtypes	clinical: primary, secondary
Gross	+/-prominent white nodules (spleen), normal appearance (most common)
Grossing notes	splenectomy grossing
Site	systemic - see spleen
Symptoms	bleeding
Prevalence	uncommon
Blood work	thrombocytopenia, antiplatelet antibodies
Prognosis	dependent on underlying cause
Treatment	corticosteroids, possibly splenectomy

Immune thrombocytopenic purpura, abbreviated ITP, is a rare condition.

It is also known as idiopathic thrombocytopenic purpura.

General

• A common non-trauma reason for splenectomy.

Presentation:

• Bleeding - usually.

Blood work:

• Thrombocytopenia.
• Antiplatelet antibodies.

Treatment:

• Usually treated with corticosteroids.
  • Possibly retuximab.
• Refractory cases get a splenectomy.

Prevalence:

• Uncommon.

Classification

• Primary - diagnosis of exclusion.
• Secondary.
  • Autoimmune.
    • Systemic lupus erythematosus.
  • Viral.
  • Bacterial - possibly Helicobacter pylori.

Gross

Features:

• Typically ~ 100 grams.
• +/-Prominent white nodules (AKA Malpighian corpuscles) - uncommon.

Microscopic

Features:

• Germinal centres in white pulp (~55% of cases)
  • Classically described as "proliferative".
• Neutrophils in the red pulp (~67% of cases).
• Macrophages in the red pulp (~25% of cases). †

Notes:

• Changes not dependent on titre of antiplatelet antibodies.
• † May be a finding associated with treatment.
• The classic changes are proliferation of lymphoid germinal centres and red pulp PMNs.

Images

• ITP spleen (webpathology.com).
• ITP spleen (pathpedia.com).

Sign out

Spleen, Splenetectomy:
     - Spleen with prominent red pulp macrophages and expanded germinal 
       centres, pending hematopathology consult.

Block letters

SPLEEN, SPLENECTOMY:
- SPLEEN WITH CHANGES COMPATIBLE WITH IMMUNE THROMBOCYTOPENIC PURPURA.

Micro

The sections show spleen with increased numbers of red pulp macrophages and siderophages. Rare scattered red pulp neutrophils are seen. Rare plasma cells are seen in the red pulp. Lymphoid follicles do not show significant expansion.

See also

• Spleen.