1. Laboratory Management

2. ITP is suspected in patients with isolated thrombocytopenia Because manifestations of ITP are nonspecific, other causes of isolated thrombocytopenia need to be excluded by clinical evaluation and appropriate testing http://www.merck.com/mmpe/sec11/ch133/ch133d.html

3. Initial Work-up Complete Blood Count with platelet count and Peripheral Blood smear – Isolated thrombocytopenia is the key finding All other blood parameters are normal May be the first indication of immune thrombocytopenia peripheral blood film examination to exclude pseudo- thrombocytopenia – Giant platelets on peripheral smear suggest congenital thrombocytopenia – The WBC count and hemoglobin typically are normal, unless severe hemorrhage has occurred http://emedicine.medscape.com/article/779545-diagnosis CLINICAL PRACTICE GUIDELINES: MANAGEMENT OF IMMUNE THROMBOCYTOPENIC PURPURA August 2006

4. Laboratory Testing Evaluate secondary causes of ITP Coagulation Studies HIV Hepatitis C Other infections SLE Hypogammaglobulinemia IgA Deficiencies Monoclonal gammopathies Anemia (Coombs Test) Evan’s Syndrome Harrison’s Principles of Internal Medicine 17 th ed http://www.merck.com/mmpe/sec11/ch133/ch133d.html

5. Bone Marrow Exam Indications for Bone Marrow Examination – over 60 years of age – prior to splenectomy – presence of atypical features – poor response to first line treatment (eg. Prednisolone) – relapsed ITP following complete remission CLINICAL PRACTICE GUIDELINES: MANAGEMENT OF IMMUNE THROMBOCYTOPENIC PURPURA August 2006