Lymph nodes & spleen, nonlymphoid
Immune thrombocytopenic purpura

Topic Completed: 1 October 2012

Minor changes: 14 September 2020

Copyright: 2003-2020,, Inc.

PubMed Search: Immune thrombocytopenic purpura[TI] spleen

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Cite this page: Mansouri J. Immune thrombocytopenic purpura. website. Accessed October 24th, 2020.
Definition / general
  • Formerly called idiopathic thrombocytopenic purpura
  • Due to antiplatelet IgG produced in spleen, which binds to platelets; platelets are then removed by macrophages in spleen and liver
  • Associated with CLL, drug hypersensitivity, Hodgkin lymphoma, SLE (lupus), viral infection
  • May be related to microcirculatory changes that increase exposure of platelets to splenic macrophages and increase platelet destruction
Prognostic factors
  • Patients without prominent secondary reactive follicular hyperplasia or ceroid histiocytosis have poorer response to splenectomy
  • Steroid or immunosuppressive therapy, splenectomy if unresponsive
Gross description
  • Normal or mildly enlarged spleen, prominent Malpighian follicles
Microscopic (histologic) description
  • Secondary follicles with well developed germinal centers, histiocytes and neutrophils in red pulp, dilated sinuses, germinal centers contain platelet antigen CD41 and show phagocytosis of nuclear debris and periarterial fibrosis
  • Usually mild myeloid metaplasia or extramedullary hematopoiesis (due to megakaryocytes)
  • Variable plasma cells in marginal zone, variable foamy or ceroid laden macrophages in red pulp (due to ingestion of phospholipids from platelets)
  • Steroid treatment diminishes prominence of follicles
  • Rarely periarterial fibrosis (Arch Pathol Lab Med 1986;110:1152)
Microscopic (histologic) images

Images hosted on other servers:

Well delineated reactive
germinal center in
splenic white pulp
(H&E x100)

Striking lipogranuloma
adjacent to splenic
white pulp (H&E x100)

Diffuse proliferation
of foamy histiocytes
(H&E x100)

Extensive extramedullary
haematopoiesis with prominent
megakaryocyte and erythroblasts
present within sinusoids

Electron microscopy description
  • Increased vascularization of white pulp and marginal zones, absence of marginal sinuses
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