Commonly referred to as ITP, idiopathic thrombocytopaenic purpura is a blood disorder which prevents blood from clotting properly. ITP occurs as a result of decreased levels of platelets (types of blood cell involved in the clotting process which help to stem bleeding). People who have ITP regularly suffer with purple bruises, which are caused by the tiny blood vessels underneath the skin bleeding.
The terms idiopathic, purpura and thrombocytopaenic mean:
People who have ITP often experience the following symptoms:
ITP is generally considered to be an autoimmune disease. These occur when the immune system mistakes something harmless for a threat and starts to attack healthy tissues. Many cases of ITP are often known as immune thrombocytopaenic purpura.
Platelets, also known as thrombocytes, are tiny blood cells that play an important role in the blood clotting process. Platelets are produced by the bone marrow, circulate in the blood stream and stem bleeding by collecting together.
Two forms of ITP are apparent. They are acute and chronic:
In people who have ITP the body’s immune system mistakes the platelets for a harmful threat and starts to produce antibodies to attack the platelets. This causes the amount of platelets located in the bloodstream to drop. The antibodies attach to the platelets and are then removed from the body by the spleen, which is located in the upper abdomen.
The immune system is usually responsible for attacking threats to prevent illnesses and infections, such as viruses and bacteria. But with autoimmune conditions the system mistakes healthy tissue for threats and starts to effectively attack the body. There is no definitive reason for why the body’s immune system cannot distinguish between the harmless and the harmful, and it is unknown why the body attacks the platelets.
Children who develop acute ITP have often recently had a viral infection and it is therefore believed that the virus may trigger the abnormal immune response. In adults there is no evidence to suggest a link between ITP and infections.
The signs of idiopathic thrombocytopaenic purpura are caused by bleeding, due to the reduced quantity of platelets in the body. Symptoms include:
A low level of platelets increases the danger of bleeding, but it does not contribute to any additional symptoms, such as fatigue or pain.
In order to diagnose ITP doctors carry out a physical examination, order blood tests and take a full medical history. A medical history will include information concerning any underlying conditions you have, any conditions you have had in the past, your symptoms and any medication you are currently taking or have taken in the past.
Your doctor will carry out a physical examination to look for symptoms of ITP. During the examination they will be looking out for:
The GP may also carry out blood tests before they confirm a diagnosis. Blood tests will include:
If the test results indicate that a patient has a low level of platelets, additional tests will usually be carried out to confirm a diagnosis and determine the reasons behind the reduced platelet count, which may include bone marrow tests.
Individuals with ITP usually have normal levels of red and white blood cells.
Low platelet quantity is often the result of the body destroying platelets or not producing enough platelets. In cases of ITP the platelet quantity or count is lower than normal, since the body damages the platelets before the bone marrow is able to produce new platelets.
In some cases individuals with ITP do not display indicators of bleeding. If this is the case condition may only be diagnosed once tests have been conducted for another condition and happen to show that the quantity of platelets in the blood is low. Once other causes have been checked then ITP will usually be found to be the cause.
The course of treatment will depend on platelet numbers and the severity of symptoms. In some mild cases no treatment is required.
Adults with mild cases of ITP sometimes do not require treatment. However, their platelet count and symptoms will be monitored closely. In cases where bleeding symptoms are more severe and the platelet count is low, medication is usually prescribed.
In the vast majority of cases children are affected by acute ITP, which tends to subside fairly quickly within weeks without treatment. Treatment is recommended for children who have bleeding symptoms, but in milder cases no treatment is normally required. All children will be monitored closely regardless of whether or not they are given a formal course of treatment.
Medication is usually the first course of treatment for adults and children with ITP. Corticosteroids (normally prednisone) are usually used first, as they help to increase the platelet count by reducing the action of the body’s immune system. Steroids can have several complications and side-effects, however, and a number of people can relapse after they have stopped taking steroids.
Some medicines, including anti-D immunoglobulin and immune globulin, are administered intravenously (this means the medicine is inserted by means of a needle into a vein).
If corticosteroids are not effective other types of medication may be prescribed. This usually occurs following a splenectomy (a procedure to remove the spleen).
In some cases, where medication has been unsuccessful, it may be necessary to remove the spleen by means of a procedure called a splenectomy. In most cases this is carried out on adults with chronic ITP who have not reacted to medicines. Taking out the spleen helps to prevent damage to platelets, though it can increase the risk of infection. It is therefore highly recommended for people who have had their spleen removed to look out for symptoms of infection and seek medical attention immediately if they discover any.
If you suffer with ITP you should follow this advice:
Pregnant females who have ITP generally give birth to healthy babies without any problems. However, the baby may be born with a decreased platelet count or develop small platelet numbers shortly after birth. The platelet volume will resume a normal, stable level shortly after, without any need for treatment. However, treatment can be recommended for babies who have low platelet numbers to speed up the process of platelet numbers returning to normal.
Treatment for pregnant females suffering with ITP is dependent on the severity of the symptoms and the platelet count. Where treatment is required doctors will consider the possible effects upon the unborn child and choose the treatment type that is safest for both mother and baby.
Women who have a mild form of ITP may be able to continue their pregnancy without having any treatment, but their condition will be monitored closely.