Conquering Immune Thrombocytopenic Purpura

by admin on August 25, 2013

There are instances when a person suffers from inexplicable bleeding which normally happens after a viral illness. The likelihood that this person is suffering from Immune Thrombocytopenic Purpura (ITP) is not too far. ITP, or sometimes called Idiopathic Thrombocytopenic Purpura is a bleeding disorder wherein the body lacks enough platelets that helps blood to clot.

Viral infections mess up the immune system causing its inability to distinguish foreign substances entering the body from its own cells, it mistakenly produces antibodies against platelets. Once antibodies attached themselves to the platelets, it will be destroyed by cells called macrophages that reside in the spleen.

Symptoms

ITP leads to lower platelet count that results to:

  • Heavy menstruation for women
  • Unexplained fatigue
  • Blood in stool and urine
  • Longer span than normal bleeding from cuts and excessive bruises
  • Unexpected nose bleeding
  • Bleeding underneath the skin that looks like reddish-purple spots (petechiae) that usually occur on lower legs and on the lower lip
  • Extended bleeding gums after dental procedure
  • Rashes on the area where the cuff was placed after getting high blood pressure

Cure

Although ITP is highly treatable and usually heals by itself, there is no way to prevent it from recurring. There were several drugs and procedures that can help solve ITP issues.

  • Recent development in treating ITP is the administration of corticosteroids and depending on the current platelet level, there are different types of steroids and dosages that will be applied. Upon improvement of the platelet count, the dosage should be gradually reduced taking into consideration the level of improvement and the body’s reaction. Studies show that dependency on steroid medication is bad because of the side effects leading to osteoporosis and diabetes.
  • Platelet transfusions especially during emergency cases may be required to control significant bleeding.
  • Immunoglobulin G (IgG) blocks platelet removal and can be given between two to five days.
  • Anti-D contains antibodies to the rhesus blood group protein ‘D’ and works like IgG.
  • Splenectomy or the removal of the spleen may be considered but recurrence of ITP can be more severe, longer lasting and can bring serious issues.

Lifestyle changes

Given a person experiencing ITP, there are some lifestyle changes that one may take into consideration to contain the risk of bleeding.

  • Avoid physical contact sports and strenuous activities that increase the risk of injury. Instead, try doing physical activities without contact like jogging, walking and swimming.
  • After undergoing splenectomy, have a healthy lifestyle to prevent any viral infection which might trigger the recurrence of ITP.
  • Avoid medications that can impair platelet function.

ITP During Pregnancy

A pregnant woman suffering from a mild case of ITP can get through pregnancy without the need for any treatment. However, when the platelet level becomes very low, patients are likely to experience heavy bleeding during delivery. Treatment of ITP on pregnant women depends on the level of platelet counts as well as consideration on possible effects to the unborn baby. More often, babies delivered from the mother suffering from very low platelet count may carry over this deficiency. But in most cases, the baby’s platelet count becomes normal after some time.

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Platelets are essential in preventing bleeding and making the blood to clot. However, there are instances when our platelet count drops, resulting to different kinds of bleeding, internally and externally. Low platelet count is sometimes caused by the body not being able to produce enough platelets. Another cause is when the body’s immune system lost its ability to differentiate foreign invaders referred as pathogens from its own body cells. Once this happen, the immune system generates antibodies against its platelets, thus the drop of platelet level.

The occurrence of low platelet count is called Immune Thrombocytopenic Purpura (ITP), or sometimes called Idiopathic Thrombocytopenic Purpura. Idiopathic refers to the body’s attack of platelets for reasons still unknown. Thrombocytopenia refers to low platelet count, and Purpura refers to the purple bruises or bleeding beneath the skin.

Two types of ITP

ITP is categorized into two: Acute and Chronic.

  • Acute ITP is more common in children and usually appears immediately after a viral illness. In most cases, the platelet count does not fall too low so there is no need for treatment. This type of ITP usually recovers within two to four weeks and rarely comes back, especially on children.
  • Alternatively, Chronic ITP is more common in adults and lasts for months, sometimes years. Adults who suffer from ITP might take into consideration changing their lifestyle into a healthier one, most especially in things that needed physical attention.

Treatment

Although in most cases ITP does not need any treatment, there are several severe instances that need attention and treatment. Here are the possible ways to treat people experiencing severe ITP.

  • Medications taken orally. People experiencing acute ITP take steroids for several weeks. Once the body responds normally, the medication is stopped. People experiencing chronic ITP may or may not respond to steroid at the same phase. It might take several months to see significant improvements. Once a sign of improvement shows, medication can be gradually reduced. However, this type of medication includes side effects like weight gain and high blood sugar due to increased appetite, and mood swings.

Long-term in take of steroid is not advisable due to side-effects that might result to diabetes and osteoporosis.

  • Another form of treatment for ITP is by injecting Immunoglobulin directly to the body. Usually taken within the timeframe five days, Immunoglobulin is used if there is a need to temporarily increase platelets.
  • Rho (D) immune globulin, more commonly known as Anti-D contains antibodies to the rhesus blood group system and can also be administered thru injection. Taking Anti-D over time might cause adverse reactions like headache and fever.
  • Platelet transfusion is sometimes done especially on emergency cases but is not recommended for over time use.
  • The last option to treat ITP is by splenectomy or the removal of the spleen. The procedure needs to be done especially if the platelet count remains very low or the person’s body does not respond to other forms of treatment. This is because the spleen is where the destruction of platelets usually takes place.

Other alternative treatments for ITP are in the form of drug intake. Cyclosporin A is able to suppress some aspects in the immune system and is commonly used for transplant patients to prevent rejection of the organ. Although not all patients react to these drugs, suggested drug intake depends mainly on the person’s body anatomy, gender, and age.

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Unusual, unexplained, and excessive bleeding are the primary symptom of ITP or immune thrombocypenic purpura. Bleeding may take different forms. Some people experience this kind of uncharacteristic bleeding during medical procedures. Others may experience constant nose bleeding while women may experience heavy bleeding during menstrual period.

Most of the patients also show unexplained bruises and bleeding dots that looks more of a rash. If a person shows any of these signs, chances are they might be suffering from Immune Thrombocytopenic Purpura, which refer to a bleeding disorder due to lack of platelets. It is also known as Idiopathic Thrombocytopenic Purpura or Auto-immune Thrombocytopenic Purpura.

Causes

ITP occurs due to the body’s incapacity to produce needed platelets. Another occurrence is when the body’s immune system cells produce antibodies that destroy platelets, which until now does not have any scientific explanation. The blood is unable to clot as it is supposed to do, thus resulting to bleeding inside the body or internal bleeding. The bleeding can also occur beneath the skin or the external bleeding.

Usually, a person suffering from ITP need not undergo treatment as it is normally affected by the person’s lifestyle or activities. However, some reportedly serious complications due to exceptionally low platelet count can result to internal bleeding which proves to be fatal like bleeding of the brain (intra-cerebral hemorrhage), or gastrointestinal bleeding. This happens when platelet count drops to less than 5,000 per micro liter (μl).

Symptoms

Unusual bleeding normally is the sign of having ITP. And though having a low platelet count does not cause any pain, a person suffering from ITP might experience fatigue, being unable to concentrate properly, and uneasiness. Other signs of bleeding are as follows:

  • Blood in urine;
  • Constant nose bleeding;
  • For women, unusual heavy menstruation (menorrhagia)
  • Unexplained bruises on the skin particularly in extremities, called Purpura;
  • A group of reddish, brownish or purplish spots on the skin, called Petechiae, and;
  • Blood clots beneath the skin that look like a lumps, also called hematoma

And since ITP occur within the person’s body, it is non-communicable.

Two Types of ITP

ITP is categorized into two, acute or temporary and chronic or long lasting.

Acute ITP mainly occurs in children after a sickness that is related to viral infection. It can affect both boys and girls and normally lasts less than 6 months. Depending on the gravity of bleeding and if the platelet count did not drop too low, this may not require treatment. Children that go through this condition will improve over time and the illness hardy recur.

On the other hand, Chronic ITP in more common in adults especially women and more often lasts for least six months or more. However, some children especially those that are on their teens, can be affected by chronic ITP. Depending on the severity of the occurrence, this might not need any treatment.

Still, not all ITP incidents are tolerable and can go without any treatment. In fact, there were reported severe cases of ITP that required surgical treatments. It is still best to consult with your doctor for proper medication and advice.

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Immune Thrombocytopenic Purpura (ITP) refers to inexplicably low platelet count which might result to excessive bruising, rashes, red dots on the skin, and bleeding. ITP is also called Idiopathic Thrombocytopenic Purpura, where Idiopathic refers to unknown cause; Thrombocytopenic means not enough platelet is produced to effect blood clot, and Purpura refers to purple-red rashes.

Signs of people affected by ITP may range from mild bruises to severe bleeding. Acute ITP commonly occurs to children and usually heals after four to eight weeks without treatment. Chronic ITP normally occurs to adult and lasts longer and might also elevate to a lifelong condition.

Understanding Body Anatomy: What are Platelets?

One of the components of the blood, the platelets, also known as thrombocytes, helps the blood to clot when a person incurred an injury. If there are enough platelets, the blood will clot normally. However, in cases of people suffering from ITP, since there are not enough platelets, this will led to heavy bleeding.

Platelets are produced inside the bone marrow after which it is released into the bloodstream and goes back and forth within the body from five to seven days. The spleen, which is found between the left ribs and abdomen, removes the platelets once it completes its cycle.

Causes of ITP

The exact cause why the immune system attacks platelets remains a mystery. What is known as the cause for people to suffer from ITP can be related to the malfunctioning of the body’s immune system. The immune system produces antibodies which in turn connect to platelets for unknown reasons. The spleen recognizes the antibodies that results to the immediate removal of the platelets from the bloodstream. In most cases of the disease, especially for children, ITP occurs after a viral illness that seems to trigger the immune system to malfunction.

Risk Factors in ITP

ITP can affect children and adult, men and women alike. However, it is likely to develop on adult women than men with a ratio of one to three. One of the most common symptoms experienced by adult women is having unusually heavy menstruation (menorrhagia). Recent viral infection is another factor that can lead to ITP. Oftentimes, children are the ones affected after getting viral illnesses such as measles, mumps or a respiratory condition.

In cases of pregnant women with ITP, there is a big possibility that antibodies that connect to the mother’s platelets will cross the placenta which in turn might affect the fetus’ own platelet count. If this happens, depending on how low the platelet count of the baby once delivered or how fast the platelet count improves, the baby may or may not need to undergo treatment.

Administering medications such as corticosteroids can suppress the immune system which prevents it from destroying the platelets. Yet, it can cause serious side effect when used often and in long term. Such side effects include bone loss (osteoporosis), and high blood sugar levels that can lead to diabetes.

One of the solutions considered by people suffering from ITP is undergoing a surgery called Splenectomy, which removes the spleen. Removing the spleen will make a person permanently vulnerable to infection. People who undergo this procedure are advised to live a healthy lifestyle.

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Some people suffer from blood disorder wherein they develop rashes that comes with tiny red dots beneath the skin. Chances are they might be suffering from Immune Thrombocytopenic Purpura (ITP). Immune refers to our body’s immune system that produces antibodies. In a still unknown reason, these antibodies attached themselves to the platelets leading them to the spleen and getting destroyed in the process.

Platelets are cells that help blood to clot or stop cuts from further bleeding. The spleen is the human’s organ that destroys any cell those antibodies has attached itself into. Thrombocytopenia is the medical term that refers to the decreasing number of platelets while Purpura is refers to the purple coloration on the skin, organs, and in mucus membranes that looks like spots or patches.

The origin of almost half of the ITP-related cases is unknown, which is why ITP is sometimes referred to as “Idiopathic Thrombocytopenic Purpura” – Idiopathic means ‘the cause is unknown’.

Forms of ITP

Acute ITP normally occurs during childhood, affecting both boys and girls and is temporary in nature. More often, ITP occurs after a viral infection and generally heals between two weeks to six months even without any treatment. On the other hand, Chronic ITP usually occurs on adults and may last to about six months or longer depending on the reaction of the body. Based from medical charts, female adults have more chances of getting ITP compared to male.

Symptoms

The general symptom of ITP is bleeding which differs only in form. The most common symptoms seen on a person suffering from ITP are excessive bruising and purple spots which are usually found on extremities. Other symptoms of ITP include the following:

  • Blood in urine or stools
  • Bleeding Nose
  • Feeling of exhaustion
  • Hard to stop bleeding from cuts and bruises
  • Extended bleeding of gums after dental works
  • For women, unusual heavy menstruation

Diagnosing ITP

Since there are other illnesses related to blood, a review of medical history followed by complete physical examination is necessary to diagnose ITP. If the patient recently just came from a sickness, a thorough check on the medication is also taken into consideration. A complete blood count (CBC) is needed to check the level of platelets and once verified, a bone marrow examination will follow to rule out other related sickness.

Treatment

Almost 80 percent of acute ITP cases recover within six months even without treatment. Although there is no known lasting cure for ITP, the objective of treating ITP is maintaining the level of platelet count to avoid any bleeding issues.

  • Corticosteroid is the first option given to people who developed ITP. It slows down the immune system’s activity which prevents it from further destroying platelets.
  • Intravenous immune globulin (IVIG) is used in case of emergency especially if there is a need to immediately increase platelet count before undergoing surgery
  • Splenectomy is a medical procedure that will remove the spleen which is the main area where the platelets are destroyed

As new technological advances are being developed, new medications are being made available. Drugs like romiplostim (Nplate) and eltrombopag (Promacta) helps bone marrow produce more platelets. Another drug called Rituximab (Rituxan) decreases immune system response. Although these medications help maintain a certain level of platelet counts, still it does not prevent ITP from recurring.

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