THE THROMBOCYTOPENIC PURPURAS - RECOGNITION AND MANAGEMENT

Idiopathic thrombocytopenic purpura (ITP) and thrombotic thrombocytope nic purpura (TTP), are distinct entities. ITP is a relatively common a utoimmune disorder typically manifesting with isolated thrombocytopeni a. The acute form, more common in children, is a self-limiting, often post-viral disease. Therapy, if indicated, usually consists of a brief course of steroids or intravenous IgG. Chronic ITP, more common in ad ults, rarely remits spontaneously. Most patients respond initially to steroids, but generally the disease relapses when steroids are tapered . Splenectomy offers a 70% chance of cure. A variety of treatment opti ons exist for patients not responding to splenectomy. The treating phy sician must choose the most effective and least toxic treatment for th e individual patient. TTP is a rare, often life-threatening, multisyst em disease of unknown aetiology. Its hallmark is widespread occlusion of the microcirculation by platelet aggregates. The clinical symptoms usually respond dramatically to plasma exchange therapy. Steroids, ant iplatelet agents and vincristine may also be useful. Splenectomy shoul d be considered in patients with multiple relapses. More specific ther apy awaits a fuller understanding of the pathogenesis of this disease.