Immune-mediated thrombocytopenia

image of Immune-mediated thrombocytopenia
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The most common cause of severe thrombocytopenia is immune-mediated thrombocytopenia (IMTP). IMTP is defined by a low platelet count, normal bone marrow function, the absence of other causes of thrombocytopenia and response to immunosuppressive therapy. This chapter covers pathogenesis of primary and secondary IMTP; acquired amegakaryocytic thrombocytopenia; causes of secondary IMTP; clinical approach to primary IMTP; management of IMTP; prognosis.

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26.2 Petechiation of the buccal mucosa in a dog with primary IMTP.
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26.3 Petechiation of the inguinal region in a dog with primary IMTP.
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26.4 Ecchymoses on the ventral abdomen of a dog with primary IMTP.
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26.5 Epistaxis, as observed in this dog with primary IMTP, is a relatively common manifestation of severe thrombocytopenia.
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26.6 The brain of a dog with primary IMTP that died of intracranial haemorrhage.
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26.7 Clinical bleeding is less commonly observed in thrombocytopenic cats compared with dogs. Petechiation of the pinna of a cat with primary IMTP.
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26.8 A blood smear from a severely thrombocytopenic patient with a manual platelet count of 2 x 10/l. Note the complete lack of platelets on this blood smear (x100 objective).
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26.9 Bone marrow cytology from a patient with primary IMTP revealing megakaryocytic hyperplasia, which is an appropriate marrow response to peripheral thrombocytopenia (x100 objective).
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26.10 Bone marrow cytology from a patient with acquired amegakaryocytic thrombocytopenia. Note the lack of megakaryocytes in this patient’s bone marrow (x100 objective).
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26.11 Thromboelastography (TEG) tracing from a severely thrombocytopenic patient with primary immune-mediated thrombocytopenia. R is the reaction time (evaluates the intrinsic pathway); K is the clot formation time (measures the rapidity of clot development); Angle indicates the rate of clot formation; MA is the maximum amplitude (reflects final clot strength); G is a calculation that takes into account the MA, and reflects the overall coagulant state as normo-, hyper- or hypocoagulant. ( = 5000 x / (100 – )). Normal reference intervals are listed below each value. In this patient, the MA is significantly decreased as a result of thrombocytopenia, which would yield decreased clot strength. The 10 mm scale bar shows the exact measurements of the tracing (in case the image is magnified or made smaller on reproduction).
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