Idiopathic Thrombocytopenic Purpura

November 12, 2012

Idiopathic Thrombocytopenic Purpura

Idiopathic thrombocytopenic purpura (ITP) is a bleeding disorder that occurs when the immune system attacks the body’s blood platelets. Low levels of platelets in the blood prevent the normal clotting of the blood.

Causes and Risk Factors

Platelets help to clot the blood by clumping together to form a plug that blocks small holes in damaged blood vessels. The immune system, on the other hand, produces proteins known as antibodies to fight germs and infections. However, when the immune system produces antibodies against the platelets, they lose their ability to clot. The spleen destroys the platelets bound to antibodies.

Idiopathic thrombocytopenic purpura is a common condition that may develop in adults and children. In fact, 50 to 150 new cases per 1 million people develop each year with children accounting for 50 percent of those cases. Children usually develop acute or short-term ITP after a viral infection. The symptoms go away within a few weeks or months, and almost 80 percent of children regain their normal platelet count within a year without any treatment. Adults, especially women, are more likely to develop a chronic form of ITP. The condition is not related to an infection and may last for several years. Some children and teenagers may also develop chronic ITP. The disease can be managed with proper treatment.

Symptoms

Idiopathic thrombocytopenia purpura is characterized by groups of pinpointed red spots known as petechial rash. The spots often look like a rash and may occur due to bleeding under the skin. The bleeding may also cause purplish bruises on the skin known as purpura. Extensive bleeding can lead to the accumulation of partially-clotted blood under the skin, which appears as lumps called hematomas. Some patients may also experience bleeding from nose or gums as well as blood in urine and stool. Some women may also suffer from heavy menstrual bleeding.

Diagnosis

Apart from doing a physical examination and studying the health history of the patient, doctors may also prescribe certain laboratory tests to confirm the diagnosis for idiopathic thrombocytopenia purpura. The doctor will look for signs of bleeding and characteristic red spots or purple areas on the skin during the physical exam. Your medical history including the list of previous infections may also help provide preliminary diagnosis for the disease. The common laboratory tests include:

  • A complete blood count, or CBC test, to check for the platelet count.

  • Microscopic examination of the blood smear to determine the platelet concentration in the blood.

  • Antigen-antibody tests to identify the anti-platelet antibodies in your blood sample.

  • Bone marrow aspiration or biopsy to see whether the bone marrow is making sufficient amount of platelets. The bone marrow tests may also indicate increased amounts of megakaryocytes, early stage platelet.

Treatment

Idiopathic thrombocytopenia purpura is not a life threatening condition. The treatment depends on the severity of the symptoms and the actual platelet counts. Mild cases of ITP may not require any treatment. However, the patient should be placed under regular observation.

Corticosteroids such as prednisone are often prescribed to suppress the immune system of patients with severe ITP. However, steroids have many side effects and increase the risk of relapse once the treatment is stopped. Intravenous administration of immune globulin and anti-Rh (D) immunoglobulin may help increase the blood platelet levels.

Your doctor may recommend surgery to remove your spleen. The spleen is a small organ on the upper left part of your abdomen. It is responsible for the production of antibodies. However, removal of spleen may make you susceptible to certain diseases. You should, therefore, get vaccinated against those infections before undergoing splenectomy.

Two newer medications known as eltrombopag and romiplostim may help treat ITP in patients who do not benefit from corticosteroids and splenectomy. Some patients may also require regular hospitalization for platelet transfusion. Others may improve their platelet count by discontinuing any anti-platelet medications that they might be taking to treat some other conditions.

Pregnant women should talk to their doctor to see if they require any special medications to manage the condition during their pregnancy.

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