IDIOPATHIC THROMBOCYTOPENIC PURPURA(ITP)
ITP is an auto-immune disorder of the platelets (blood cells) leading to increased bleeding and bruising on the body. It is also referred to as immune thrombocytopenic purpura.
Platelets are blood components found in blood along with red blood cells and white blood cells. Platelets are also called as thrombocytes. They are produced in the bone marrow. Platelets help in clotting of the blood. The normal range of platelets in a healthy person is from 150000 to 450000 per cubic millimeter. A person with ITP has a platelet count as low as 20000 or less.
It is more common in children than in adults. Usually, women are more likely to develop ITP.
ITP can be classified into two types:
01 Acute ITP- Children are more prone to suffer from acute ITP especially following a viral infection. It is usually the self-limiting immune response of the body and the child is fine within 2-6 months without requiring any treatment.
02 Chronic ITP- ITP which is present for 6 months or longer is termed as chronic ITP. This form of ITP is more common in adults. It can trigger after a viral infection, with use of certain drugs, during pregnancy or due to the auto-immune response of the body.
Causes of ITP
As the name suggests, it is idiopathic i.e. of unknown cause. There is an auto-immune reaction in the body by which antibodies are formed against platelets. These antibodies get attached to the platelets and flow in the bloodstream. Spleen, which protects the body from infection, identifies these antibodies attached with platelets as abnormal and destroys them. As a result, the platelet count gets low which results in easy bleeding and bruising on the body.
ITP may be associated in people with infections like HIV, Hepatitis C or H pylori.
Signs and Symptoms of ITP
Generally, an individual with ITP may be symptom-free. But when the platelet count gets significantly low, the signs and symptoms observed are:
01 Pinpoint bleeding spots (petechiae) on skin
02 Easy bruising (purpura) on the skin and mucous membranes
03 Bleeding from nose
04 Bleeding from gums
05 Heavy menstruation
06 Prolonged bleeding from cuts or injuries
07 Fatigue
08 Significant bleeding can lead to hematoma; lumps of blood under the skin
When the platelet count goes below 5000 than there are possibilities of bleeding in the brain and other internal organs.
Diagnosis of ITP
The diagnosis is usually made by excluding other underlying diseases or use of certain medications like Aspirin, Ibuprofen responsible for low platelet count and bleeding disorder.
A complete blood count (CBC) determines the value of platelets in the blood. In ITP, the value of RBC’s and WBC’s are normal and only platelet count gets low.
Tests for blood clotting time and bleeding time, where clotting time is normal and bleeding time is prolonged.
Blood Smear- To confirm the platelet count by observing the blood smear under the microscope.
Detecting antibodies associated with platelets in the blood.
Bone marrow biopsy or aspiration – This is rarely done. In ITP, the bone marrow shows normal or greater number of megakaryocytes (early form of platelets). The platelets are normal in the bone marrow and are destroyed in the blood stream and in the spleen.
Spleenomegaly (enlargement of spleen) excludes the diagnosis of ITP.
Treatment of ITP
Most children and adults with mild ITP do not require any treatment. A regular platelet count monitoring is sufficient to manage ITP.
However, in children and adults with very low platelet count and significant bleeding calls for treatment.
Treatment includes
Corticosteroids- oral or as intravenous injections becomes the first choice of treatment for the conventional doctors. However, prolonged use of steroids are responsible for side-effects like osteoporosis, diabetes, weight gain and cataract.
01 Intravenous Immunoglobulin (IVIG) in cases of severe bleeding, immunoglobulins when given intravenously helps in increasing the platelet count rapidly but its effect lasts only for a couple of weeks.
02 Platelet Transfusion helps in cases of emergency but is helpful for a short period as the immune response of the body destroys even the newly received donor platelets.
03 Anti-D immunoglobulin – for patients with Rh (D)-positive blood group
04 Spleenectomy in rare cases when body in not responding to medications, removal of spleen is done in order to prevent the destruction of platelets. Spleen is a organ which helps in protecting the body against infections so by removing the spleen the body gets more prone to catching infections.
05 Administering other immuno-suppressive drugs
Management
ITP cannot be prevented but its complications can be avoided or reduced.
Avoid medicines like ibuprofen, aspirin that affects platelets and increase the chances of bleeding.
Avoid injuries, which can cause bleeding, and bruises.
Effective and quick management of infections.