Idiopathic Thrombocytopenic Purpera

Idiopathic Thrombocytopenic Purpura

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Introduction • Idiopathic thrombocytopenic purpura (ITP), also called immune thrombocytopenic purpura, is a bleeding disorder in which your blood has difficulty clotting due to an unusually low number of platelets. Platelets (thrombocytes) are colorless blood cells that stop blood loss by clumping together at the site of a blood vessel injury and forming plugs in vessel holes.

Introduction • People with idiopathic thrombocytopenic purpura, because of their low platelet count, tend to bruise easily and bleed longer when injured. Nosebleeds and bleeding gums also are common. • Idiopathic thrombocytopenic purpura is often divided into two categories: acute and chronic. Acute ITP is the most common form and occurs most frequently in children, typically after a viral infection. It usually goes away on its own within six months. Chronic ITP lasts longer than six months and is more

Introduction • Treatment of idiopathic thrombocytopenic purpura depends on your signs and symptoms and platelet count. If no bleeding problems are present and the platelet count isn't too low, treatment for idiopathic thrombocytopenic purpura usually isn't necessary. The goal of treatment for both children and adults is to create a safe platelet count and avoid bleeding complications. Treatment

Signs And Symptoms • Easy or excessive bruising (purpura) • Superficial bleeding into your skin that appears as a rash of pinpoint-sized reddish-purple spots (petechiae), usually on your lower legs • Prolonged bleeding from cuts • Spontaneous bleeding from your gums or nose • Blood in urine or stools • Unusually heavy menstrual flows

Petechia e

Causes • The exact cause of idiopathic thrombocytopenic purpura is unknown. This is why it's referred to as idiopathic, which means "of unknown cause." However, scientists do know that with ITP, the immune system malfunctions and begins attacking platelets as if they were foreign substances.

Causes • Antibodies produced by your immune system attach themselves to the platelets, marking the platelets for destruction. The spleen, which helps your body fight infection, recognizes the antibodies and removes the platelets from your system. The result of this case of mistaken identity is a lower number of platelets than normal.

Causes • Normally, you have anywhere from 150,000 to 450,000 platelets per microliter of circulating blood. As the number of your platelets decreases, your risk of bleeding increases. The greatest risk is when platelet count falls very low — below 10,000 platelets per microliter. At this point, internal bleeding may occur despite a lack of any injury, although this is rare.

Causes • In children with acute ITP, the disorder often follows a viral illness, such as the mumps, a respiratory infection or a flulike illness. It may be that such an infection sets off the immune system, triggering it to malfunction. But ITP in adults isn't linked to infections.

Screening & Diagnosis

 Complete Blood Count (CBC)  Blood Smear  Bone Marrow Examination

CBC • This common blood test is used to determine the number of white and red blood cells and platelets in a sample of your blood. With ITP, white and red blood cell counts are usually normal even though the platelet count is low. In adults with mild ITP who have no signs or symptoms, a low platelet count may be discovered coincidentally when this blood test is performed for a different purpose.

Blood Smear

• A sample of your blood is placed on a slide and observed under a microscope. This test is often used to confirm the number of platelets observed in a complete blood count.

Bone Marrow Examination • help identify the cause of a low platelet count is a bone marrow examination. Platelets are produced in your bone marrow. An underlying problem, such as certain causes of anemia or leukemia, can affect your bone marrow's production of platelets and decrease your platelet count. • With ITP, however, your bone marrow is normal because the low platelet count is caused by immune-related destruction of platelets, not by

Treatment  Corticosteroids

 Intravenous Immunoglobulin (IVI  Surgery  Immunosuppressant Drugs

Corticosteroids • The first line of therapy for ITP is the use of corticosteroids, usually prednisone. Prednisone can help raise your platelet count by decreasing the activity of your immune system. Once your platelet count is back to a safe level, you can gradually discontinue taking the prednisone under the direction of your doctor. In general, this takes about four to six weeks.

Corticosteroids • About 70 percent of adults experience a relapse after discontinuing the corticosteroids. A new course of corticosteroids may be pursued; however, long-term use of these medications has potentially serious side effects, including cataracts, high blood sugar, increased risk of infections, loss of calcium from bones, menstrual irregularities, suppressed adrenal gland hormone production, thin skin, obesity, weakness in shoulders and thighs, easy bruising and slower wound healing. You and your doctor will want to weigh the benefits of the medication against these risks. If you've taken corticosteroids for longer than three months, your doctor will likely recommend

IVIG • If you need a rapid elevation in platelet count, such as in the case of critical bleeding or in preparation for surgery, you may receive medications such as immunoglobulin or anti-(Rh) D immunoglobulin through a needle placed in your vein (intravenously). These medications are quick and effective, but their benefits usually wear off in a couple of weeks.

Surgery • If you have moderate to severe ITP and the initial course of prednisone isn't helping, your doctor may recommend removal of your spleen (splenectomy). This eliminates the main focus of platelet destruction in your body and improves your platelet count. Improvement is usually seen in a couple of

Immunosuppressant Drugs • Other possible treatments may include the use of immunosuppressant drugs such as rituximab (Rituxan) — the safest and most commonly used of this group — cyclophosphamide (Cytoxan), azathioprine (Imuran) or vinca alkaloids (Vincasar, Velban), but side effects can be risky.

Self Care  Avoid platelet-impairing medications (such as aspirin and ibuprofen)  Limit alcohol (can impair blood clotting)  Choose low-impact physical activities (increase the risk of injury and bleeding)