Diagnosis

388 The platelet count may be <5-100 x 109/L. Platelet size often 4 on the blood film, reflected in 4 MPV; represents production of young platelets by the reactive bone marrow. Diagnosis of ITP is confirmed by exclusion of a secondary (other autoimmune or drug-induced cause) or hereditary cause of thrombocytopenia in a patient with a normal physical examination, no splenomegaly and normal bone marrow examination. The demonstration of platelet antibodies or increased platelet associated Ig may be confirmatory but neither positive nor negative results are definitive. A small proportion of patients have associated DAT +ve AIHA (Evans' syndrome), most of whom have an underlying disorder (CLL, lymphoma, SLE).

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