Immune Thrombocytopenic Purpura

Thrombocytopenia is seen commonly in patients with rheumatic disorders. In general, thrombocytopenia is due to one of three mechanisms: reduced production, sequestration, or increased platelet destruction. In outpatients, the most common cause of thrombocytopenia is immune thrombocytopenia. Immune thrombocytopenia encompasses a broad group of disorders in which the rate of immune-mediated platelet destruction surpasses the rate of platelet production. This paper discusses the diagnosis of immune thrombocytopenia, its mechanisms, and potential therapies for this problem. Acute therapy is with corticosteroids and intravenous immunoglobulin. Splenectomy is used if these fail. There also are other second-line therapies for treatment of patients with refractory thrombocytopenia. Potential toxicities of therapy are reviewed within the context of patients with rheumatic disorders.