512 Idiopathic Thrombocytopenia Purpura a female patient, ask for the date of the last menstrual period, whether recent menses lasted longer and were heavier than usual, or whether she is pregnant. Ask if the patient has had HIV testing.

PHYSICAL EXAMINATION. Physical examination of patients with acute ITP reveals diffuse petechiae (red to purple dots on the skin, 1 to 3 mm in size) or bruises on the skin and in the oral mucosa. Chronic ITP patients may have no obvious petechiae. Other clinical features of ITP include ecchymoses (areas of purple to purplish-blue, fading to green, yellow, and brown with time), which can occur anywhere on the body from even minor trauma. In both types of ITP, the spleen and liver are often slightly palpable, with lymph node swelling. Ongoing assessment throughout patient management is essential to evaluate for signs of life-threatening bleeding.

PSYCHOSOCIAL. Children with acute ITP are usually brought to the pediatrician by highly anxious parents, who are concerned with the sudden appearance of easy bruising, petechiae, and occasionally, bleeding gums and nosebleeds. Because these symptoms are so commonly associated with leukemia, parents and children need swift diagnosis and reassurance. Pregnant women are concerned about their own health, as well as the health of the fetus.

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