Summary about Disease
Autoimmune Thrombocytopenic Purpura (ITP), also known as Immune Thrombocytopenic Purpura, is an autoimmune disorder where the immune system mistakenly attacks and destroys platelets, which are essential for blood clotting. This leads to a lower-than-normal platelet count (thrombocytopenia), increasing the risk of bleeding and bruising. ITP can be acute (short-term) or chronic (long-term).
Symptoms
Easy or excessive bruising (purpura)
Pinpoint-sized red or purple spots on the skin (petechiae)
Prolonged bleeding from cuts
Spontaneous nosebleeds or bleeding gums
Heavy menstrual periods
Blood in urine or stool
Fatigue
Enlarged spleen (rare)
Internal bleeding (rare but serious)
Causes
ITP is an autoimmune disease, meaning the body's immune system attacks its own tissues. In ITP, the immune system produces antibodies that bind to platelets. These antibody-coated platelets are then recognized and destroyed by the spleen. The exact trigger for this autoimmune response is often unknown, but potential factors include:
Viral infections (e.g., hepatitis C, HIV, Helicobacter pylori)
Certain medications
Pregnancy
Underlying autoimmune disorders (e.g., lupus, rheumatoid arthritis)
Sometimes, it occurs with no identifiable trigger (idiopathic)
Medicine Used
Corticosteroids (e.g., prednisone): These suppress the immune system to reduce platelet destruction.
Intravenous Immunoglobulin (IVIG): Provides a high dose of antibodies that can temporarily block the destruction of platelets.
Anti-RhD Immunoglobulin (WinRho): Used in Rh-positive individuals to prevent platelet destruction.
Thrombopoietin Receptor Agonists (TPO-RAs) (e.g., romiplostim, eltrombopag): Stimulate the bone marrow to produce more platelets.
Rituximab: A monoclonal antibody that targets B cells, which are involved in antibody production.
Splenectomy (surgical removal of the spleen): A last resort option if other treatments fail. The spleen is a major site of platelet destruction.
Is Communicable
No, ITP is not contagious. It is an autoimmune disorder and cannot be spread from person to person.
Precautions
Avoid activities that could lead to injury or trauma (e.g., contact sports).
Use a soft-bristled toothbrush and avoid vigorous flossing.
Avoid medications that can increase bleeding risk, such as aspirin and NSAIDs (nonsteroidal anti-inflammatory drugs).
Inform all healthcare providers about the ITP diagnosis before any procedures or treatments.
Consider wearing a medical alert bracelet or carrying a card indicating the condition.
Get vaccinated against preventable infections such as influenza and pneumonia.
How long does an outbreak last?
The duration of an ITP episode varies.
Acute ITP: Usually seen in children and often resolves within a few weeks or months.
Chronic ITP: Lasts longer than 6 months and may require ongoing management. Some individuals may achieve remission, while others may experience relapses.
How is it diagnosed?
Complete Blood Count (CBC): Shows a low platelet count (thrombocytopenia).
Peripheral Blood Smear: Examines the blood cells under a microscope to rule out other causes of thrombocytopenia.
Bone Marrow Biopsy (Aspiration/Biopsy): May be performed to rule out other bone marrow disorders or cancers that can cause low platelet counts.
Testing to Rule Out Other Conditions: Blood tests to exclude other causes of thrombocytopenia, such as viral infections, autoimmune diseases (e.g. Lupus), and medication-induced thrombocytopenia.
Physical Exam and Medical History: Helps to assess for other potential causes or contributing factors.
Antibody Testing (Antiplatelet Antibody Test): Detects the presence of antibodies against platelets but is not always reliable or necessary for diagnosis.
Timeline of Symptoms
The onset of symptoms can be gradual or sudden.
Initial Stage: Mild bruising or petechiae may be noticed.
Progression: As the platelet count drops, symptoms can worsen, with more frequent and severe bruising, nosebleeds, and bleeding gums.
Chronic ITP: Symptoms may fluctuate over time, with periods of remission and relapse.
Important Considerations
ITP can be life-threatening in severe cases due to the risk of serious bleeding, especially intracranial hemorrhage (bleeding in the brain).
Treatment should be individualized based on the severity of the condition, the patient's age, and other medical conditions.
Pregnant women with ITP require careful monitoring to ensure the safety of both the mother and the baby. The infant's platelet count must be checked after birth.
Living with a chronic condition like ITP can be challenging, and emotional support and patient education are important aspects of care.
Regular follow-up with a hematologist (blood specialist) is essential for ongoing management.