Cooper N, Ghanima W. Immune Thrombocytopenia. N Engl J Med. 2019 Sep 5;381(10): 945-955. doi: 10.1056/NEJMcp1810479.
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Immune thrombocytopenia (ITP) is an autoimmune disease characterized by isolated thrombocytopenia. Patients may be asymptomatic at presentation or they may present with mild mucocutaneous to life-threatening bleeding. Although only 5% of patients with ITP present with severe bleeding,  bleeding leading to hospital admission within 5 years after diagnosis develops in approximately 15%.  Irrespective of bleeding problems, patients with ITP often report fatigue and impaired health-related quality of life.  The risk of venous thromboembolism is twice as high among patients with ITP as among persons in the general population; the management of venous thromboembolism may be especially problematic given the concomitant risk of bleeding.