Idiopathic Thrombocytopenic Purpura (ITP) – What Is It?
What Is ITP?
Idiopathic Thrombocytopenic Purpura (ITP) is an immune disorder that manifests itself through abnormal blood clotting. The term “immune thrombocytopenia” is used more commonly to refer to this condition.
ITP is caused by a low platelet count in the blood. Excessive bleeding and bruising can occur as a result of ITP.
The bone marrow is responsible for the production of platelets. When they clump together, they form a clot, which seals cuts or small tears in the blood vessel and tissue walls, resulting in the cessation of bleeding. When your blood doesn’t have enough platelets, it clots more slowly, and as a result, it is possible to experience internal bleeding as well as bleeding on or beneath the skin.
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When someone has immune thrombocytopenic purpura (ITP), they develop numerous purple bruises on their skin or mucous membranes inside their mouth. In addition to bruises, petechiae, which are small red or purple dots on the skin, can appear with these bruises. Petechiae is frequently confused with a rash.
ITP is a medical condition that can affect both children and adults of any age. According to the data available so far, the development of ITP appears to differ between men and women at certain ages. Adult females may be more susceptible to ITP.
There are two distinct subtypes of ITP: acute (short-term) and chronic (long-term).
Acute ITP is a shorter form of ITP that usually lasts less than six months. It is the most common type of ITP, and it primarily affects children. It frequently occurs in children after they have contracted an infection or illness caused by a virus.
Chronic ITP is a long-term infection that can last for six months or longer. Generally speaking, it affects adults, but it can also affect adolescents and children. Even people who have severe forms of chronic ITP can live for decades. Most people who have chronic ITP can stop treatment at some point and maintain a safe platelet count.
What Exactly Causes ITP?
The term, “idiopathic,” refers to a condition that has an unknown origin. This term was previously used to describe ITP because the cause was unknown when the disease was first identified.
It is now well established that the immune system plays a significant role in the development of ITP, which has led to the disease’s more recent designation as immune thrombocytopenia.
In adults, this condition may be triggered by infection with HIV, hepatitis, or H. pylori (the type of bacteria that causes stomach ulcers). In most children, the disorder follows a viral illness, such as the mumps or the flu.
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Symptoms of ITP
The following are the most common symptoms of ITP:
- Profuse bleeding during surgery
- Prolonged bleeding from cuts
- Abnormally heavy menstruation
- Blood in the stool
- Blood in the urine
- Bleeding from the gums (like in dental procedures)
- Spontaneous nosebleeds
- Pinpoint-sized petechiae on the lower legs
- Bruises that occur easily
Some individuals with ITP exhibit no symptoms.
What Is the Procedure for Diagnosing ITP?
Your doctor will perform a comprehensive physical examination and inquire about your medical history and any current medications you are taking.
Your doctor will also order a complete blood count (CBC), among other tests. Recommended follow-ups may include a blood test to check for platelet antibodies.
A blood smear will also need to be performed, and this involves placing a small amount of blood on a glass slide. The slide is then observed under a microscope to examine the platelets and other blood cells.
If your doctor determines that you have a low platelet count, a bone marrow test may also be recommended. If you have ITP, the bone marrow in your bones will be normal. If your bone marrow is abnormal, it is almost certain that your low platelet count is the result of a disease other than ITP.
Available Treatment Options for ITP
It is up to your doctor to determine the best course of treatment for you based on the number of platelets in your blood and the frequency and amount of bleeding you have experienced. In some cases, medical intervention is not required. Children who develop the acute form of ITP, for example, typically recover without treatment within a few weeks or months.
Adults who have milder cases of ITP may also be able to avoid treatment in some instances. However, your doctor will likely monitor your platelets to make sure you don’t need any additional treatment in the future. If your platelet count drops too low, you run the risk of bleeding and will often require treatment.
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If you or your child requires medical attention, your doctor will almost certainly start with medication to alleviate your symptoms. ITP is treated with several different medications, which are listed below.
Intravenous Immunoglobulin (IVIG)
The administration of intravenous immunoglobulin may be necessary if your bleeding has reached a critical level or you are scheduled for surgery. In these cases, your platelet count needs to be increased as soon as possible.
This medication is intended for people who have Rh-positive blood with functional spleens.
Your doctor may prescribe a corticosteroid such as prednisone to increase your platelet count. Once your platelet count is back to a safe level, you can gradually discontinue taking the drug under the direction of your doctor. Long-term use of corticosteroids is not recommended because they can increase your risk of infections, high blood sugar, and osteoporosis.
Helicobacter pylori, the bacteria that causes the vast majority of peptic ulcers, has been linked to ITP in a small number of people. Some individuals have benefited from antibiotic therapy to eradicate helicobacter pylori, which has been shown to increase platelet counts.
Thrombopoietin Receptor Agonists
Medications such as romiplostim (Nplate) and eltrombopag (Promacta) work by stimulating the production of platelets in the bone marrow, which helps prevent bruising and bleeding. These types of drugs can increase your risk of blood clots.
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Your doctor may recommend spleen removal surgery (splenectomy) if you have severe ITP and your symptoms or platelet count do not improve after taking medication.
The spleen makes antibodies (proteins) that help fight infections. In ITP, these antibodies destroy platelets by mistake, and removing the spleen will therefore reduce the destruction of platelets.
Surgery may raise your risk of infections, so your doctor may give you vaccines to help prevent infections before your surgery.
Some people who have ITP with severe bleeding may require platelet transfusions and hospitalization. Platelet transfusions may also be needed before surgery.
Your doctor may recommend that you make the following changes to your lifestyle:
- Engage in low-impact activities rather than competitive sports or other high-impact activities since this can help reduce the risk of injury, bruising, and bleeding.
- Consume alcohol in moderation because it has the potential to impair blood coagulation.
- Exercise caution when using over-the-counter medications such as aspirin and ibuprofen since they may impair platelet function.
Treatment of Idiopathic Thrombocytopenia During Pregnancy
In pregnant women who have ITP, the condition usually will not affect the baby. However, some babies may be born with or develop low platelet counts soon after birth.
The babies’ platelet counts almost always return to normal without any treatment. However, treatment can speed up recovery in babies whose platelet counts are very low.
Treatment for ITP during pregnancy depends on a woman’s platelet count. If treatment is needed, the doctor will take a close look at the possible effects of the treatment on the unborn baby.
Women who have mild cases of ITP usually can go through pregnancy without treatment. Pregnant women who have very low platelet counts or a lot of bleeding are more likely to have heavy bleeding during delivery or afterward. To prevent heavy bleeding, these women usually receive some sort of treatment.
Outlook for Immune Thrombocytopenic Purpura
Most people who suffer from ITP do not have a serious or life-threatening illness.
Children with acute ITP who do not receive treatment typically recover within six months or less.
ITP that is chronic can last for several years or even decades. Those suffering from severe cases can still expect to live for decades. Many people with ITP can safely manage their condition and avoid long-term complications.
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If you or your child develops unexplained bruises or bleeding, it is critical that you seek medical attention right away. A wide range of illnesses can cause bleeding and bruising issues, including the flu. It is possible that the diagnosis will be ITP, and that the prognosis will be favorable. In some cases, treatment is required to prevent or manage complications that may arise.
It is important to seek medical attention as soon as possible if symptoms return, even if you are currently taking medication for your condition or your condition appears to be improving for a period of time.
Can ITP be cured?
While there is no cure for ITP, many patients find that their platelet counts improve following treatment. What proves difficult for many ITP patients is finding the treatment that works for them without unwanted side effects.
Some patients report that changing their diet or lifestyle helps them feel better. The disease can go into remission for a long time, perhaps for the remainder of a person’s life, but ITP can also recur. There is currently no way to predict the course of the disease.
What is the cause of idiopathic thrombocytopenic purpura?
It is not known what causes some people to develop ITP, but it is known that ITP causes the body’s immune system to destroy healthy platelets, which can lead to easy or excessive bruising or bleeding.
Some cases appear after a viral or bacterial infection, after immunizations, after exposure to a toxin, or in association with another illness such as lupus or HIV (human immunodeficiency virus). ITP is not usually considered a disease that can be passed from one generation to another.
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Karim Tobgy, RPh was born and raised in Cairo, Egypt. He graduated from Cairo University in 2009 and has been a practicing pharmacist for 12 years and is certified in Sterile Products (IV) & USP (797). The most rewarding part of his job is seeing the impact of his care as a Pharmacist on the patients’ quality of life. He is currently precepting students from Marshall B. Ketchum University. In his free time, he enjoys watching documentaries and playing soccer.