Summary about Disease
Idiopathic Thrombocytopenic Purpura (ITP), now often referred to as Immune Thrombocytopenic Purpura, is an autoimmune disorder characterized by a low number of platelets in the blood. Platelets are blood cells that help stop bleeding. In ITP, the immune system mistakenly attacks and destroys platelets. This can lead to easy bruising, bleeding, and petechiae (small, pinpoint red or purple spots on the skin).
Symptoms
Easy or excessive bruising (purpura)
Superficial bleeding into the skin that appears as pinpoint-sized reddish-purple spots (petechiae), usually on the lower legs
Bleeding from the gums or nose
Blood in urine or stool
Unusually heavy menstrual flow
Fatigue
Enlarged spleen (rare)
Internal bleeding
Causes
ITP is caused by the immune system attacking and destroying platelets. The exact reason why this happens is not fully understood, but it is believed that the immune system mistakenly identifies platelets as foreign and produces antibodies to destroy them. It is often triggered by:
Viral infections (e.g., HIV, hepatitis C, chickenpox)
Bacterial infections (e.g., H. pylori)
Medications
Vaccinations (rare)
Autoimmune diseases (e.g., lupus, rheumatoid arthritis)
Medicine Used
Corticosteroids (e.g., prednisone): Suppress the immune system.
Intravenous Immunoglobulin (IVIg): Provides healthy antibodies that can temporarily prevent the immune system from attacking platelets.
Anti-D Immunoglobulin: Similar to IVIg, but specifically for Rh-positive individuals.
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, which is a major site of platelet destruction. (Less common, reserved for severe cases).
Fostamatinib: A spleen tyrosine kinase (SYK) inhibitor, which blocks a signaling pathway involved in platelet destruction.
Is Communicable
No, ITP is not communicable. It is an autoimmune disorder and cannot be spread from person to person through contact or other means.
Precautions
Avoid medications that can affect platelet function: Such as aspirin, ibuprofen, and other NSAIDs.
Minimize activities that could cause injury or trauma: To reduce the risk of bleeding.
Inform healthcare providers about your ITP: Before any procedures or surgeries.
Maintain good hygiene: To prevent infections, which can sometimes trigger ITP flares.
Get vaccinated: Against preventable illnesses as per your doctor's recommendation, while being mindful of rare vaccination related triggers.
How long does an outbreak last?
The duration of ITP can vary. It can be acute (short-term) or chronic (long-term).
Acute ITP: Typically lasts less than 6 months, often occurring in children after a viral infection. Many children recover fully without treatment.
Chronic ITP: Lasts longer than 6 months. Some individuals may experience periods of remission (no symptoms) followed by relapses (recurrence of symptoms). Chronic ITP can persist for years or even a lifetime.
How is it diagnosed?
Complete Blood Count (CBC): Shows a low platelet count.
Peripheral Blood Smear: Examines blood cells under a microscope to rule out other causes of thrombocytopenia.
Bone Marrow Aspiration and Biopsy: May be performed to rule out other bone marrow disorders (such as leukemia) but is not always necessary.
Testing for Underlying Conditions: May include tests for HIV, hepatitis C, H. pylori, and autoimmune disorders.
Ruling Out Other Causes: It's crucial to exclude other potential causes of low platelet counts, such as medication-induced thrombocytopenia or inherited platelet disorders.
Timeline of Symptoms
The onset of symptoms can be sudden or gradual.
Initial Phase: May involve easy bruising, petechiae, nosebleeds, or gum bleeding.
Progression: If untreated, symptoms may worsen, leading to more significant bleeding, such as heavy menstrual periods or blood in the urine or stool.
Chronic Phase: In chronic ITP, symptoms may persist for months or years, with periods of remission and relapse. The timeline is highly variable depending on the individual and the effectiveness of treatment.
Important Considerations
Individualized Treatment: Management of ITP should be tailored to the individual's specific situation, including the severity of thrombocytopenia, the presence of bleeding symptoms, and other underlying health conditions.
Monitoring: Regular monitoring of platelet counts is essential to assess the effectiveness of treatment and to detect any changes in the condition.
Risk of Bleeding: Individuals with ITP are at increased risk of bleeding, especially with very low platelet counts. They should be educated about the signs and symptoms of bleeding and when to seek medical attention.
Quality of Life: ITP can affect quality of life due to fatigue, bleeding symptoms, and the side effects of treatment. Support groups and counseling can be helpful.
Pregnancy: ITP during pregnancy requires careful management to protect both the mother and the baby. Platelet counts may need to be closely monitored, and treatment may be necessary to prevent bleeding complications during delivery.