Which of the following is generally not seen in idiopathic thrombocytopenic purpura (ITP) –
Idiopathic thrombocytopenic purpura

There are two clinical subtypes of primary I.T.P, acute and chronic both are autoimmune disorders in which platelet destruction results from the formation of antiplatelet antibodies.

Pathology

The principal morphologic lesions of thrombocytopenic purpura are found in the spleen and bone marrow but they are not diagnostic.
The point to stress is that despite the increased destruction of platelets in spleen the spleen size remains normal.  

Bone Marrow

Bone marrow reveals a modestly increased number of megakaryocytes.
These findings are not specific for autoimmune thrombocytopenic purpura but merely reflect accelerated thrombopoiesis, being found in most forms of thrombocytopenia resulting from increased platelet destruction.
The importance of bone marrow examination is to rule out thrombocytopenias resulting from bone marrow failure.
A decrease in the number of megakaryocytes goes against the diagnosis of I.T.P.

Clinical Features

Chronic ITP occurs most commonly in adult women, younger than age 40 years.
Female to male ratio is 4: 1.
The clinical signs and symptoms associated with I.T.P are non-specific for this condition but they are rather reflective of thrombocytopenia.
The disease is often insidious in onset and is characterized by bleeding into the skin and mucosal surfaces.
Cutaneous bleeding occurs in the form of pinpoint haemorrhages, petechiae or ecchymoses. Often there will be a history of easy bruising, nosebleeds, bleeding from the gums and haemorrhages into soft tissues from relatively minor trauma.
Sometimes disease may first manifest with melena, hematuria or excessive menstrual flow.
Subarachnoid haemorrhage and intracerebral haemorrhage are serious consequences of thrombocytopenic purpura but fortunately are rare in treated patients.
More common in females
Petechiae, ecchymosis and bleeding
Palpable splenomegaly
Increased megakaryocytes in bone marrow