Platelets are important blood components to maintain your overall health. Therefore, you must be aware of the issues and conditions that are related to it. One condition about your platelets is the Immune Thrombocytopenic Purpura. What is it and how can you deal with it? You can answer that questions after you have read this article up to the end.
Immune Thrombocytopenic Purpura is the condition wherein the platelets, the blood cells for blood clot formation, are damaged by the immune system. It can result in low platelet count that can lead to more serious complications to your health. Thus, having a low level of platelet can cause bleeding and bruising in the areas of your skin, outer linings of organs as well as mucous membranes. This condition is also called as the idiopathic thrombocytopenic purpura or ITP.
Understanding immune thrombocytopenia purpura
Immune thrombocytopenic purpura is a type of bleeding disorder wherein your immune system destroys your blood platelets. Platelets are very crucial for normal blood clotting. However, if you have too low platelet count in your blood, ITP develops. The presence of antiplatelet autoantibodies is the principal cause of the disease. ITP is also simply called as immune thrombocytopenia. Thrombocytopenia is referred as a decrease of your platelets or thrombocytes.
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The purpura relates to the visible hallmarks or purplish areas in your skin as well as mucous membranes like your mouth lining. The bleeding occurs in these areas because of the low platelets count. Immune thrombocytopenia can be triggered by drugs associated with an infection on the pregnancy period. It can also occur due to immune disorders like systemic lupus erythematosus. Almost half of the cases are identified as idiopathic, which means that the cause is unknown. The ITP abbreviation is commonly used with this condition. The abbreviation both stands for immune thrombocytopenic purpura and idiopathic thrombocytopenic purpura.
The immune thrombocytopenic purpura may happen if specific immune system cells are producing antibodies that attack and destroy your platelets. When the cause of the immune reaction is not clear, the condition is known as the idiopathic thrombocytopenic purpura. Idiopathic is referred as the “of unknown cause.” Platelets enable your blood clot through clumping together to plug tiny holes in the destroyed blood vessels. When antibodies are produced, it can attach to the platelets. As a result, your body destroys the platelets which carry the antibodies.
In some cases with children, the ITP may lead to a viral infection and illness such as flu and mumps. These infections are triggered by the immune system malfunction. On the other hand, it can lead to long-term chronic disease among adults after a viral infection. The disease can be triggered by the use of particular drugs, especially during pregnancy or as part of the immune disorder.
According to scientific studies, immune thrombocytopenia can affect women more often compared to men. Furthermore, it is also more likely to happen in children than adults. When it comes to children, the disorder equally affects both boys and girls.
Increased breakdown of platelets
In people who suffer from immune thrombocytopenic purpura, the antibodies that are created by the immune system attach themselves to your platelets. It is the main cause of platelet destruction. Your spleen plays an important role in helping your body to fight infection. It also recognizes the antibodies and eliminates the platelets for your system. With this, the result of this condition of mistaken identity is a lower amount of circulating platelets than is normal.
Based on studies, the usual platelet count is in the middle of 150,000 and 450,000 platelets per microliter of circulating blood. Most individuals with immune thrombocytopenia have a platelet count that is below 20,000. The platelets are important for the blood clot, as it decreases, the risk of bleeding increases. According to research studies, the most dangerous platelet count is when it falls below 10,000 platelets per microliter. At this point, internal bleeding can happen even you don’t have any injury.
Risk factors for ITP
Anyone can experience from idiopathic thrombocytopenic purpura. It can occur to people of all ages, but the following factors can trigger the risk:
- Current viral infection. Most of the children with immune thrombocytopenia can develop the disease after a viral infection or illness. These viral infections include measles, mumps as well as respiratory infection.
- Your sex. It is believed that women are two to three times more prone to develop ITP compared to men.
Symptoms of ITP
Sometimes, the symptoms of ITP are unknown. When they do, the symptoms of immune thrombocytopenic purpura include the following:
- Superficial bleeding in the skin, more often around the shins, causing a skin rash which looks like pinpoint red spots or petechial rash. It usually happens in the lower legs.
- Easy bruising and excessive bleeding (purpura).
- Nosebleed or bleeding in the mouth and gums.
- Blood in urine or stools.
- Uncommon heavy menstrual flow in women.
Exams and tests for ITP
When you have a condition of immune thrombocytopenic purpura, blood tests will be conducted to monitor the count of your platelets. A biopsy or bone marrow aspiration can also be done. The following are some of the tests that doctors conduct for those who have ITP.
- Blood smear. This test is performed to check if the amount of platelets observed is in a complete blood platelet count. In this test, the sample of blood is placed on a slide. It is under observation with the use of a microscope.
- Bone marrow exam. The role of this exam is to make sure that the number of platelets observed is also in a complete blood count. Meanwhile, the American Society of Hematology doesn’t endorse this exam for children with immune thrombocytopenia.
The platelets are produced in your bone marrow. Bone marrow is spongy, soft tissue in the middle of large bones. In some conditions, the sample of bone tissue and the enclosed marrow can be removed in a process known as the bone marrow biopsy. The doctor can also perform a bone marrow aspiration. This process can eliminate some of the liquid portions of the marrow. In most of the cases, these procedures are conducted at the same time (bone marrow exam.)
In the case of individuals with ITP, the bone marrow can be normal since the low platelet count is initiated by the destruction of platelets in your bloodstream and spleen. It is not a problem with the bone marrow.
Treatment for immune thrombocytopenia
People with mild ITP only need regular monitoring and platelet checks. In the cases of children, ITP can go away without having any treatment. But, some children need to undergo treatment. On the other side, adults are commonly begun to use a steroid medicine known as the prednisone. If you don’t have signs of bleeding and your platelet count is never too low, you don’t need any treatment. Too low number of platelets can be very dangerous. Thus, it can lead to serious internal bleeding. For some cases, splenectomy, the surgery to remove the spleen is highly recommended. Though, other drug treatments are also recommended instead. For some people, the treatment side effects are more burdensome compared to the effects of the disorder itself.
When the immune thrombocytopenic purpura disease is getting worse, the following treatments can also help:
- Infusions of high-dose gamma globulin, an immune factor
- Medicine such as danozol (Danocrine) that is taken by the mouth
- Several drugs that can subdue the immune system
- Drugs that can stimulate the bone marrow to produce more platelet count
- Anti-RhD therapy for individuals who have certain blood types
People who have immune thrombocytopenia purpura (ITP) are restricted to take ibuprofen or warfarin, as well as aspirin. Thus, these drugs can interfere with the function of the platelets or blood clotting. With the use of these drugs, bleeding can happen.
With the help of early treatment, the chance of remission (a symptom-free period) is fine. In unusual cases, immune thrombocytopenia can lead to a long-term condition among adults and reappear even after the symptom-free period.
In diagnosing ITP, the doctor will try to eliminate the potential causes of bleeding and low platelet count. They can exclude underlying diseases or medications that you or your child has been taking. Even more important, the doctor will also ask about you and your child’s medical record, conduct a physical exam and conduct one or more tests.
If not given immediate actions, the ITP can lead to other health complications. Some of these complications are the sudden and extreme loss of blood from your digestive tract. Bleeding into your brain is also highly possible. Bleeding in the brain is fatal, so you must take immediate action.
In case of pregnant women with ITP, the disease can’t usually affect the baby. But, it is also necessary to test the baby’s platelet count soon after birth. If you are pregnant and have a low platelet count, and experience bleeding, you have an increased risk of heavy and extreme bleeding on your delivery. In this case, you and your doctor must talk about the treatment to keep a stable platelet count. It is also recommended to take into account its effects on your baby.
When to contact a medical expert
If you observe that new symptoms develop, and if there is severe bleeding, you can go to the emergency room. You can also call the local emergency number like 911. You can also set an appointment with your doctor if you or your child encounters warning signs that make you worried.
Unstoppable bleeding is a medical emergency. It is advisable for you to directly seek help from the experts to avoid more serious problems. Meanwhile, if you and your child experience uncontrolled bleeding, the common first-aid technique to do is to apply pressure to the affected area.
Alternative names for ITP
Immune thrombocytopenic purpura or ITP’s alternative names include the following:
- Immune thrombocytopenia
- Bleeding disorder-Idiopathic thrombocytopenic purpura
- Bleeding disorder-ITP
- Low platelet count-ITP
For medications with ITP, your doctor can talk about supplements and medications whether you need to stop or continue using it. Thus it can constrain the function of the platelets. Examples of these medications are ginkgo biloba, ibuprofen (Motrin B, Advil, and others), aspirin and warfarin (Coumadin.)
The doctor may prescribe with these following medications to fight against ITP.
- Drugs that suppress your immune system. The doctor can recommend you to start with an oral corticosteroid like prednisone. This drug can support to increase your platelet count through lowering the activity of your immune system. When your platelet count falls to the safe level, you can stop taking the drug under the advice of your doctor. Generally, it may take around two to six weeks. In adults, some may experience a relapse after they stop taking corticosteroids. Long-term use of this drug is not recommended because of the high risks of its side effects. These side effects are high blood sugar, cataracts, thinning of bones (osteoporosis) and increased risk of infections.
- Injections to increase your blood count. When corticosteroids don’t work, the doctor can give you an injection of immune globulin (IVIG.) This medication is also used for critical bleeding or if you need to increase your blood count before surgery quickly. Potential side effects of this include vomiting, headache, and low blood pressure.
- Drugs to increase blood platelet production. Thrombopoietin receptor agonists like romiplostim (Nplate) and eltrombopag (Promacta) can help the bone marrow to produce more platelets. The side effects of this medication are dizziness, headache, nausea, vomiting and increased risk of blood clots.
- Other immune-suppressing drugs. Rituximab (Rituxan) also supports to lower the immune system’s response that is destroying platelets. With this, your platelet count can be increased. Its potential side effects are fever, low blood pressure, rash as well as a sore throat.
If the condition persists despite the treatment, the doctor can recommend other drugs that can suppress your immune system and increase your platelet production. Some of these include the removal of the spleen (splenectomy) and other drugs like Azathioprine.