It is a rare bleeding disorder wherein there is a low platelet count in the blood stream. Platelets play a big role in blood clotting. In case of ITP, one's own immune system attacks healthy platelets and destroys them. This auto immune action leads to destruction of platelets and it manifests itself in unstoppable bleeding or bruises on the skin.
Presence of ITP may display no symptoms. However, the following symptoms could occur:
- Skin bruising readily and easily (purpura).
- Rash of needle point purple-reddish spots on the skin, especially, lowerlimbs
- Unstoppable and prolonged bleeding from normal nicks and cuts
- Sudden bleeding from nose, gums, in the urine and heavy menstrual blood flow.
- Tiredness & fatigue
ITP can occur to any one and at any age. Its exact cause is not known. Typically, women are more than twice likely to develop it than men are. Also, recent viral infections tend to cause ITP especially in children. However, children usually fully recover without needing any treatment. In some cases, use of certain types of medication can also lead to ITP.
ITP affects both adults and children. While children are able to recover fully without any treatment, often times, in adults it tends to be chronic. Normal platelets count in healthy adults is greater than 150,000 per microliter of blood in circulation. In cases of ITP, it falls as low as 20,000. Lower platelet count increases the risk of excessive bleeding and any fall below 10,000 causes internal bleeding without any injury.
ITP is typically diagnosed by isolating the root cause of bleeding. If there are no other reasons responsible for the symptoms, only then ITP diagnosis is undertaken. This may include
- Review of complete medical history
- Physical examination
- Complete blood picture
- Smear sampling of blood
- Examination of bone marrow (biopsy)
The typical line of treatment for ITP is preventing complications arising from bleeding and ensuring safe platelet counts. In children, natural recovery takes place within a few months or in rare cases, within a few years. Moderate cases of ITP in adults require just regular checks of platelet counts and getting off some forms of medication that inhibit platelet activity ( eg: blood thinners viz. disprin, ibuprofen, etc).
In emergency cases, cocktails of platelet concentrate and medication is rapidly transfused into the body.
Some other forms of treatment include usage of low intensity steroids for long periods of time, flushing out H. Pylori bacteria from the gut and usage of immune suppressant drugs.
Frequently used medication may include:
- Steroid (corticosteroids): These medicines help raise platelet count by neutering the immune system activity but they need to be gradually weaned off as relapses may occur after discontinuation. However, their long term use is likely to cause other serious side effects. There is also biologic therapy available for those where steroids don't help.
- Drugs to improve bone marrow platelet production.
- IV immune globulin. In cases of critical need where the blood count has to increase right away (eg: before a surgery), these medications give rapid but temporary benefits.
In case the first line does not work, the spleen is surgically removed. This results in removal of the main organ that aids platelet destruction. It is not a routine surgery and not everyone is eligible for it. Also, a lack of spleen in the body makes you more susceptible to infections permanently for a lifetime.