ITP: Idiopathic Thrombocytopenic Purpura

ITP or Idiopathic Thrombocytopenic Purpura, one of the blood disorders is largely an autoimmune disease with the body’s own immune system attacking and destroying the body’s platelets or due to the Immunoglobulin G (IgG) auto-antibodies on the platelet surface.

In the term, ITP or Idiopathic Thrombocytopenic Purpura, `Idiopathic’ means the cause is unknown, `thrombocytopenic’ is blood with less number of platelets and `purpura’ is a person who is suffering with too many wounds.

As the name implies, people suffering from this blood disorder have blood cells which are thoroughly normal, however, the disorder is seen in the platelets which are small cells that help in clotting minor cuts and wounds.

Platelets or thrombocytes that are made in your bone marrow, circulate through the blood vessels and help in clotting by sticking together to seal small cuts or breaks in tiny blood vessels. However, when people have problems in their platelet, then their blood doesn't’t clot easily and they lose more blood than normal people. Common symptoms which are indicative in such disorders are nose bleeding which takes long to stop or bleeding in the intestines.

Now arises the question on how does this disorder of the blood occur. While the real cause in not yet found by medical sciences, it is believed that people suffering from ITP form antibodies which kill the blood platelets.

In the case of normal people antibodies in the body help in fighting with bacteria or virus whereas in people with ITP, the same antibodies destroy the body’s own platelets. This disease commonly affects children between the age group of 2 to 4 years or young women; however, it is not hereditary.

Some of the most common symptoms of ITP are bleeding of the gums, nose bleeding or any other bleeding which takes long to stop; heavy menstrual bleeding among women or in very rare cases, symptomatic bleeding in the brain which could be life threatening. ITP could be of two types – acute which is usually short term or chronic which is long lasting.

The acute usually lasts for 6 months or lesser than that and is quite common among young children due to viral infection. It can get cured on its own without any medication. However, the chronic ITP lasts for longer and is usually for more than 6 months and affects adults. The cases of young women being affected by chronic ITP are 2 to 3 times more common than men.

Once the disorder is identified, the treatment is based on the age groups as well as extent of the disorder. In the case of children, usually no medication is administered and the disease often runs its course whereas in the case of the adults, in the initial stages, a drug called prednisone is administered. In some cases the removal of spleen or splenectomy is advised as spleen is the major location for destruction of platelets.

As the causes and risk factors are unknown for this disorder except in the case of children when sometimes it is due to viral infection, the prevention of this disorder is also unknown. However, if the disorder does not respond to the medication administered during the initial stages, then medications like oral danazol, gamma globulin injections or medicines which suppresses the immune system is usually given to patients.

These patients should avoid taking medicines like aspirin, ibuprofen, and warfarin as there is a likelihood of these medicines hindering the smooth functioning of the platelet and blood clotting, and bleeding may occur.

Whatever the mode of treatment in adults, the main aim of treatment is to increase the number of blood platelets. However, it is not equivalent to curing the disease.

While patients might be taking prednisone to control the platelet count for a prescribed period, if they stop taking it the platelet count gets back to its earlier number. In such cases, spleen is removed. In the case pregnant women, diagnosing this disorder is not very easy as quite a few of them have mildly low platelet level during pregnancy which becomes normal after the delivery.

According to statistics, in the US the cases of ITP is approximately 66 cases per 1,000,000 per year with an average of 50 cases per 1,000,000 per year among children. In the case of chronic refractory ITP there are found to be about 10 cases per 1,000,000 per year.

It is found that Kuwait has the highest number of cases of 125 per 1,000,000 per year, though the cause is unknown. Some of the complications seen in severe cases of ITP are intra cranial or other major hemorrhage, severe blood loss, adverse effects of corticosteroids as well as pneumococcal infections if the patient has had a splenectomy.

To avoid complications, the patients need to be educated on the repercussions and they need to have regular follow-up tests to ensure that there is no further reduction in platelet count. They should also avoid medications based on aspirin as well as avoid getting wounded.