Idiopathic Thrombocytopenic Purpura (ITP) - Types, Symptoms, Causes, Diagnosis, and Treatment

What Is Idiopathic Thrombocytopenic Purpura?

Idiopathic thrombocytopenic purpura, now called ITP or immune thrombocytopenia, is an immune blood disorder where the blood does not clot properly. It can result in severe and spontaneous bruising and bleeding due to low level of platelets in the blood.

The bone marrow is responsible for platelet production, and these platelets clump together to stop bleeding by forming a blood clot. The blood clot seals the small tear in the blood vessel walls. Now if the platelet level is low, it results in slow blood clot formation and prolonged bleeding. This condition also increases the risk of internal bleeding or bleeding under the skin.

ITP patients have purpura, which are numerous purple bruises the skin and mucous membranes. Sometimes, these bruises look like petechiae (pinpoint red or purple dots) on the skin, which look like rashes. Younger women and older men are more susceptible to this condition. Children become more susceptible to get ITP after a viral infection, such as chickenpox, measles, and mumps.

Treatment is usually not needed if the patient does not have signs of bruising and if the platelet count is not too low. Medications to increase the platelet count or spleen removal surgery might be necessary for more severe cases.

What Are the Types of Idiopathic Thrombocytopenic Purpura?

The types of ITP are:

1. Acute (short term) ITP - it lasts for six months or less and is the most common blood disorder in kids.

2. Chronic (long term) ITP - it lasts longer than six months and commonly affects adults.

3. Primary ITP - it occurs on its own.

4. Secondary ITP - it occurs with another condition.

What Are the Symptoms of Idiopathic Thrombocytopenic Purpura?

Some patients do not have symptoms, but if they do, the common signs and symptoms of idiopathic thrombocytopenic purpura are:

• Easy bruising.

• Petechiae (pinpoint bruising), commonly on the legs.

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• Severe bleeding during surgery.

• Spontaneous and frequent nosebleeds.

• Blood in the stool.

• Heavy menstruation.

• Prolonged bleeding from small cuts.

• Gum bleeding.

• Blood in the urine.

What Causes Idiopathic Thrombocytopenic Purpura?

Idiopathic means of unknown cause. Because the cause was unclear in the past, it was named idiopathic thrombocytopenic purpura. But now it is clear that the immune system results in this condition, which is why it is called immune thrombocytopenia now. It has been found that the immune system destroys platelets by producing antibodies. Then these platelets are removed by the spleen, which results in low platelet count. It is also believed that the immune system affects platelet production. ITP usually develops following a viral infection in kids.

Risk Factors:

• Autoimmune diseases (rheumatoid arthritis, lupus).

• Chronic infections.

• Pregnancy.

• Some types of cancer.

Idiopathic Thrombocytopenic Purpura and Pregnancy:

In pregnant women, if the platelet count is not very low, then treatment is not required and only regular monitoring will do. But if the counts are very low, it can result in severe bleeding during and after delivery. Consult a doctor to come up with a treatment plan.

How Is Idiopathic Thrombocytopenic Purpura Diagnosed?

If you are experiencing symptoms of ITP, your doctor will take a complete medical history and perform physical examinations. Then if needed, the doctor will suggest you to get the following tests done:

• Complete blood count - to check for low platelet count.

• Liver and kidney function test.

• A blood test to check for platelet antibodies.

• Bone marrow test - in case your platelet count is low, a bone marrow test might be needed.

In ITP patients, the bone marrow will be normal, as platelets are destroyed in the blood and spleen after they leave the bone marrow.

How Is Idiopathic Thrombocytopenic Purpura Treated?

Treatment is not usually necessary for kids with acute ITP, as it will heal without treatment in about six months. In adults with no symptoms or almost normal platelet count also, treatment is no needed. But, the doctor will monitor the platelet and other blood cell count to check if you would have to be put under treatment. The treatment options in symptomatic patients are:

Medications:

1. Corticosteroids - Prednisone is used to increase your platelet count by inhibiting the activity of the immune system.

2. Intravenous immunoglobulin (IVIg) - In case of severe bleeding or if the patient needs surgery, then intravenous immunoglobulin is given to increase platelet count in a short time.

3. Anti-D Immunoglobulin - For patients with Rh-positive blood, anti-D immunoglobulin is used to increase platelet count.

4. Rituximab - This medicine destroys the immune cells that destroy platelets.

5. Thrombopoietin receptor agonists (Romiplostim, Eltrombopag) - Promotes bone marrow to produce more platelets, which prevents bruising and spontaneous bleeding.

6. Other immunosuppressants (Cyclophosphamide, Azathioprine, Mycophenolate) - They inhibit the activity of the immune system.

7. Antibiotics - To treat Helicobacter pylori infection, which is a bacterial infection associated with ITP.

Surgery:

In patients who have severe ITP and if medicines are not helping, then the doctor will suggest surgical removal of the spleen (splenectomy). This surgery is not performed in kids because most children get better on their own all of a sudden. Getting your spleen removed increases the risk of infections.

Lifestyle Alterations:

You might be advised to make some lifestyle modifications like:

• Do not take drugs that affect blood clotting, such as Aspirin, Ibuprofen, and blood thinners like Warfarin and Heparin.

• Avoid alcohol consumption.

• Avoid sports and high-impact activities that can result in injury.

• Choose low-impact activities.

What Are the Complications of Idiopathic Thrombocytopenic Purpura?

The possible complications include:

• Severe bleeding.

• Bleeding into the brain (can be fatal).

But the prolonged use of corticosteroids can result in:

• Osteoporosis.

• Infections.

• Diabetes.

• Cataracts.

• Loss of muscle mass.

For more information on ITP, consult a hematologist now.