Immune thrombocytopenic purpura (ITP) is a disorder of platelets. Platelets (thrombocytes) are tiny power packed cells in blood that helps to maintain and propagate clotting mechanism. Thrombocytopenia is term used for low platelet count. It can occur either due to defective production, increased consumption or destruction of platelets. In immune thrombocytopenic purpura there is easy bruising and bleeding even from minor injury because of reduced platelets. This condition can be present in both adults as well as children.
Purpura is a medical term for purple bruises under the skin and mucus membrane, which is common in thrombocytopenia.Children are likely to develop purpura after viral illnesses such as measles and chickenpox. However, the condition is self limiting in children. In adults the cause may be different and may have long term effect.
If platelet count is too low, there is risk of internal bleeding which is often life-threatening. There are several treatment options available in case of severe form of immune thrombocytopenic purpura. This condition is also called idiopathic thrombocytopenic purpura.
Causes Of Immune Thrombocytopenic Purpura
Immune thrombocytopenic purpura (ITP) is a bleeding disorder in which the immune system of the body mistakenly starts destroying the platelets produced in bone marrow.Platelet count in blood is said to be low if it is less than 1,50,000 cell/mm3. If the cause of this typical immune reaction remains unknown, it is also called idiopathic thrombocytopenic purpura. Children as well as adults both can suffer from ITP. In immune thrombocytopenic purpura the antibodies produced by immune system think that platelets are foreign body and they start destroying them.
The exact cause remains still unclear, but most often among children the trigger is viral infection. Diseases such as flu, measles, and mumps are known to cause this condition. In adults too, it can occur after viral infection, but other causes include certain drugs quinine, cyclosporine, phenylbutazone, antibiotics etc and pregnancy.
The normal platelet count is between 150000 and 450000 per microliter in the blood. In ITP, the platelet count can be as low as 10000 per microliter. Platelet count as low as this can cause bleeding from internal organs. Women are more likely to get affected by ITP.
Signs And Symptoms Of Immune Thrombocytopenic Purpura
Immune thrombocytopenic purpuras are of two type; acute or short term and chronic or long term. Acute ITP is more common and resolves in less than 6 months. Chronic ITP persists for more than 6 months. Since platelets play pivotal role in clotting of blood most symptoms are those related to bleeding. Bleeding can be in skin, mucus membrane or in internal organs. Bleeding is prolonged even after minor injury.
Uncommonly ITP may not present with any symptoms and the disease is incidentally diagnosed during laboratory blood test performed for some other health issue. Common presenting symptoms are as follows:
- Easy bruising after mild injury.
- Tiny hemorrhagic spots on skin arising called petechiae, most often found on legs.
- Sudden bleeding from nose.
- Uncontrolled bleeding from gums while brushing teeth.
- Blood in stool due to bleeding in stomach and intestine.
- Bleeding in urine.
- Conjunctival bleeding.
- Menorrhage (excessive and profuse menses).
- Prolonged bleeding after minor surgery work.
- Uncontrolled post partum bleeding.
Treatment Options For Immune Thrombocytopenic Purpura
Immune thrombocytopenic purpura is diagnosed with clinical history of bleeding pattern as well as with blood test. Often when the symptoms are not present, ITP is diagnosed when the blood test detects something wrong with the platelet count. Peripheral blood smear during CBC test of blood is of great value in diagnosing ITP.
Treatment depends on many factors. When the symptoms are not present, only observation and certain precautions may be needed. In most children ITP is caused after respiratory illness, infection or vaccination. In such cases the condition is self limited. It means the disease resolves after few weeks or months. Adults with minor form of ITP may not require any treatment. Only monitoring of platelet count from time to time and watch for any bleeding from gums etc may be required.
- Corticosteroid is the mainstay treatment if needed. This medication suppresses the immunity and hence the platelet count can increase. There is no defect in production from bone marrow. The platelets are destroyed only when the immune system attacks it while it is circulating in blood. Platelet count becomes normal within 2 to 3 days of use of corticosteroids. In some patients corticosteroids have known to produce long term remission.
- Intravenous immunoglobin are used when the bleeding remains uncontrolled. It is used as life saving in emergency.
- Immunosuppressant medicines are also useful to inhibit the immune system. They are used with varied success.
- In case of chronic cases of ITP, surgical removal of spleen is a definite choice if all conventional measures fail. At least two weeks prior to spleen surgery, patient is given pneumococcal vaccine. In certain cases vaccine against haemophilus influenza and meningococcus may also be necessary.
Patients suffering from ITP must avoid activities especially contact sports that can increase the risk of bleeding and injury. Person must also avoid drinking alcohol as it can interfere in clotting mechanism.