Autoimmune Thrombocytopenia - Causes, Symptoms, Diagnosis and Treatment

What Is Autoimmune Thrombocytopenia?

Autoimmune thrombocytopenia is a bleeding condition that affects both children and adults. This condition is caused due to low platelet levels in the bloodstream. This condition is also known as idiopathic thrombocytopenic purpura (ITP) or immune thrombocytopenia. This condition is characterized by red or purple bruises on the skin. These bruises have an increased tendency to bleed. This condition can be acute or chronic in nature. The acute variant originates suddenly and can last up to two months. The chronic variant can be persistent for more than six months.

What Are Platelets?

Platelets are a type of cell called thrombocytes that help clot the blood. In the event of any injury that may cause the rupture of the blood vessels, the platelets attach themselves to the vessel's wall and stop the bleeding. Spontaneous bleeding can occur if there is a deficiency in the number of platelets in the body. This reduction in the number of platelets can be known as thrombocytopenia.

What Are the Types of Autoimmune Thrombocytopenia?

There are two types of autoimmune thrombocytopenia. This includes

• Acute Autoimmune Thrombocytopenia: The acute variant is seen in children after a viral infection. This type of thrombocytopenia does not last more than six months.

• Chronic Autoimmune Thrombocytopenia: The chronic variant is more commonly seen in adults. This condition is more common in women. The duration of chronic autoimmune thrombocytopenia is more than six months.

What Are the Causes of Autoimmune Thrombocytopenia?

The various causes of autoimmune thrombocytopenia include the following:

1. Immune Response: Our body’s immune system could be responsible for this condition. This happens when the immune cells perceive our own cells as threats and start attacking them. When our immune system attacks the platelets, it may lead to thrombocytopenia.

2. Viral Infections: Several viral infections can cause thrombocytopenia. Conditions such as dengue, hantavirus infections, and HFRS (hemorrhagic fever renal syndrome) can cause thrombocytopenia.

3. Bacterial Infections: Bacterial infections can cause thrombocytopenia. Infections by bacteria such as klebsiella and pseudomonas can cause disruption in the clotting mechanism.

4. Genetic Factors: Some individuals are at a higher risk of thrombocytopenia due to their genetic makeup. This can be inherited from the parents.

What Are the Symptoms of Autoimmune Thrombocytopenia?

The symptoms of thrombocytopenia can be mild, moderate, or severe. Sometimes there could be no symptoms at all. The various symptoms of thrombocytopenia can include the following:

• Purpura: Purpura refers to purplish skin discoloration. This is caused due to the pooling of blood under the superficial layer of the skin due to improper clotting. The pooling of blood gives a purple appearance to the skin.

• Petechiae: Petechiae are small purple or red dots on the skin. This could also be confused with rashes.

• Bleeding Gums: Autoimmune thrombocytopenia can also be associated with bleeding gums. There could be spontaneous bleeding of the gums or bleeding during dental appointments or brushing.

• Heavy Menstrual Bleeding: There could be heavy menstrual bleeding in the case of ITP.

• Tiredness: Autoimmune thrombocytopenia is also associated with extreme tiredness. This is more common in ITP that is caused due to infections.

• Heavy Bleeding After Injury: Heavy bleeding following any cuts or abrasions to the skin could occur. This type of bleeding can be quite hard to stop.

• Blood in Stools: In very rare cases, there can be blood in stools. This may also be associated with constipation.

• Bleeding Through the Nose: There can be bleeding through the nose in the case of autoimmune thrombocytopenia.

How Is Autoimmune Thrombocytopenia Diagnosed?

The diagnosis of autoimmune thrombocytopenia is made based on analyzing various factors such as:

• Physical Examination: This is done to check for any bleeding under the skin. Physical examination helps to check for any pinpoint bleeding under the skin that can be seen as petechiae.

• Medical Examination: Medical history helps to check for any previous history of any medical conditions that may lead to delay in the clotting mechanism. It may also help find other medical conditions that may cause similar symptoms, such as bacterial or viral infections.

• Blood Examinations: Blood examinations help in identifying platelet levels. It will also help identify other infections or conditions that can lead to thrombocytopenia.

How Is Autoimmune Thrombocytopenia Treated?

The treatment of autoimmune thrombocytopenia depends on the severity of the condition. Mild cases of this condition may not require any treatment. It may only require the person to take precautions as they are at a greater risk of bleeding. The treatment will depend on the platelet count and the clotting time of a person.

• After starting medications to treat thrombocytopenia, children respond better than adults.

• The various medication used in the treatment of autoimmune thrombocytopenia include:

1. Corticosteroids such as Prednisolone.

2. Immunoglobulin therapy.

3. Immunosuppressants such as Rituximab.

4. Thrombopoietin receptor agonists such as Eltrombopag.

What Are the Other Treatments Available for Autoimmune Thrombocytopenia?

The other treatments that are available for autoimmune thrombocytopenia include

1. Surgery: In cases of severe thrombocytopenia, the doctor may consider the removal of the spleen. The spleen is the organ responsible for the production of antibodies. Hence removal of the spleen can prevent the platelets from being attacked by the immune cells.

2. Curing Underlying Infection: If thrombocytopenia is caused due to any underlying infection, it is important to cure it first.

3. Avoiding Certain Medications: The doctor may avoid medications that increase the risk of prolonged bleeding, such as Aspirin.

4. Platelet Transfusion: Platelet transfusion can help patients with severe clotting disorders. These platelets are obtained from blood banks.

How to Reduce the Risk of Autoimmune Thrombocytopenia?

The ways to reduce the risk of autoimmune thrombocytopenia can include:

1. Preventing injuries that can cause bleeding. Using gloves, helmets, and other protective wear to prevent potential injuries.

2. Avoid medications that can cause bleeding. Medications such as Aspirin put a person at a greater risk of bleeding.

3. Though it is difficult to prevent the occurrence of thrombocytopenia, the complications can be prevented. Necessary precautions should be taken to prevent complications such as excessive bleeding.

How Long Does Autoimmune Thrombocytopenia Take To Cure?

• Acute autoimmune thrombocytopenia can take a few weeks or months to cure. Mostly this condition does not recur.

• Chronic autoimmune thrombocytopenia can last for many years. A chronic condition can be quite serious and require constant treatment.

Conclusion:

Autoimmune thrombocytopenia is a condition that causes a reduction in platelet levels. This can be caused due to various reasons, such as infections or other conditions. When a person is affected, the clotting time after an injury increases. This can cause excessive bleeding, petechiae, or purpuras. Hence, a medical opinion should be obtained if these symptoms are observed. In the case of existing disease, care should be taken to avoid injuries, and medications should be taken to prevent further aberrations.