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Immune or Idiopathic Thrombocytopenic Purpura
What is Idiopathic Thrombocytopenic Purpura?
Idiopathic Thrombocytopenic Purpura or ‘ITP’ is an auto-immune
bleeding disorder for which the cause is not known. In this
condition the blood doesn’t have enough platelets to carry out its
normal clotting functions - instead the platelets are destroyed by
antibodies created by the person’s own immune system. There is one
new case of ITP each year per 100,000 people and it often develops
in women between the ages of 20 and 40. There is currently no cure
for ITP.
ITP is also sometimes referred to as ‘immune thrombocytopenic
purpura’ and can occur during pregnancy, due to an infection or
immune disorders like systemic lupus erythematosus. It may also be
caused by cancer of the blood (leukemia) or other cancers that have
spread to the bone marrow.
If a person has ITP, all their blood cells are normal except for
their blood platelets. These are the cells that act to close minor
cuts and wounds and form blood clots. When there are too few
platelets in the blood the body is easily bruised and if an injury
occurs bleeding continues for a long time. If the platelets or
‘thrombocytes’ become very few - bleeding may occur without injury.
What are the Symptoms of Idiopathic Thrombocytopenic Purpura?
People who have ITP may bleed from the nose, gums, digestive or
urinary tracts or (very rarely) bleeding within the brain occurs.
Sometimes tiny red spots called petechiae occur on the skin and
there is easy bruising.
How is Idiopathic Thrombocytopenic Purpura Diagnosed?
Your doctor or hematologist will take a thorough medical history and
do a physical exam. He will also ask about any medications you are
taking and do a complete blood exam or ‘count’. If the blood test is
positive for a very low platelet count it will confirm that you have
ITP.
A bone marrow test may be done in an effort to establish whether
there are enough platelet forming cells or ‘megakaryocytes’ in the
marrow
A second blood sample may be taken to rule out lupus erythematosus
or other infections.
Types of Idiopathic Thrombocytopenic Purpura
There are two types of ITP: An acute and a chronic form of
the disease. The acute type of ITP is commonly seen in young
children and both sexes may get the disease. ITP may come on after a
viral infection and about 85 % of children recover within one year
without any recurrences.
Idiopathic thrombocytopenic purpura is considered to be chronic in
nature if it has lasted more than 6 months and it may appear at any
age. There are more adults with ITP and more females are affected by
the disease.
How is ITP Treated?
The way in which ITP is treated really does depend on how severe the
condition is and in some cases no treatment is needed or given.
Where it is necessary the aim of treatment is to increase the number
of platelets in the blood but this doesn’t actually cure the
disease.
Corticosteroid hormones like prednisone are usually prescribed for
several weeks or more than a month in some cases but when the
medication is stopped the blood platelets may start to decrease
again.
Sometimes the spleen is removed since it is the organ that produces
the antibodies that kill the blood platelets. If the patient is a
fairly healthy individual this is not as serious as it sounds.
If there is internal bleeding or surgery is going to be performed a
platelet transfusion may be given but is not a general treatment for
ITP.
If medications are the cause of ITP the treatment will probably be
discontinued and if any infections are present these will be treated
with medicines to control it since the infection may be the cause of
low platelet levels.
Other treatments may include:
Chemotherapy
The aim of chemotherapy is to use drugs to normalize the production
of certain cells. Chemotherapy as a treatment for ITP is used to
slow the formation of cells that make the wrong antibodies in the
immune system. Medications may include azathioprine, vincristine,
cyclophosphamide, cyclosporine or vinblastine.
Androgens
Androgens like Danazol are natural hormones and are sometimes
helpful to ITP patients.
Plasma Exchange
Plasma exchange can help to reduce the number of antibodies in the
blood and entails filtering the blood through a machine that removes
the plasma that contains the antibody and replacing it with a
substitute.
Intravenous Immune Globulin
This is a special globulin that contains several antibodies that is
given into the veins. It is only a temporary solution and side
effects are possible during infusion.
Rho(D) Immune Globulin IV
Rho(D) Immune Globulin IV is an antibody that slows down the
destruction of platelets and can be used if the patient is Rh
positive and has not had a splenectomy. It is also a temporary
solution to ITP.
Protein A Column Therapy
This is a form of treatment in which the patient’s plasma is passed
through a special column to remove the antibodies which cause the
platelets to be destroyed.
Coping with Idiopathic Thrombocytopenic Purpura
If you have ITP you will be advised to help reduce or prevent
symptoms by:
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Avoiding bruising or bumping yourself.
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Using an electric razor when shaving.
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Blowing your nose gently and maintaining adequate room moisture to
prevent nosebleeds.
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Wearing hard-soled shoes, gloves, and long pants when doing outside
work.
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Using a soft or sponge toothbrush.
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Avoiding aspirin or aspirin-like medications such as Motrin,
ibuprofen, or other anti-inflammatory drugs as they can affect blood
clotting mechanisms.
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Being alert to your body and any changed or new symptoms. Call your
doctor immediately if you have any of the following:
ITP can be successfully managed and you can help your doctor to help
you by becoming informed about your condition and taking steps to
safeguard your health and safety. Talk to your doctor about your
illness and together you will have the best chance of adequately
controlling symptoms and keeping you well.
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