Idiopathic thrombocytopenic purpura (ITP), also known as immune thrombocytopenic purpura, is an autoimmune disease that leads to decreased platelet counts in the blood and excessive, sometimes spontaneous, bleeding. ITP occurs in about 100 per 1 million people a year. Half of the cases are present in children. However, affected children are usually very young and their cases are temporary. Here is a look at everything you need to know about this rare blood disorder, including its symptoms, causes, diagnosis, and treatments.
ITP Symptoms
Some people with ITP are asymptomatic, but others show a few common signs and symptoms. For example, one characteristic of the condition is a purpuric rash caused by internal bleeding. The rash looks like small red or purple spots, usually on the lower legs. Frequent bruising and abnormal bleeding—such as spontaneous nose bleeds or prolonged bleeding after an injury, gum bleeding after dental work, blood in urine or stool, or a, unusually heavy menstrual flow—are additional signs of ITP.
ITP Causes
At one time the cause for ITP was idiopathic, or unknown. Now, however, medical professionals have determined the cause to be an immune reaction to blood platelets. People with ITP produce antibodies that attach to platelets which their immune systems then destroy. This destruction results in a low platelet count. Because the body doesn’t have enough platelets, which are needed for forming blood clots, bleeding cannot be effectively stopped.
In children, ITP is triggered following a viral infection such as the flu or mumps. As mentioned earlier, the first symptom is a sudden, purpuric rash which is visible a few days or weeks after the infection, but infection related ITP usually resolves within six months.
Although more likely to be temporary in children, ITP tends to be chronic in adults. There are few different factors that can cause ITP in adults such as certain medications, pregnancy, or an immune disorder.
ITP Risk Factors
- Age: Children two to four years of age following a recent viral infection are most likely to develop ITP.
- Gender: Women are twice as likely as men to be affected by ITP.
- Pregnancy: An overactive spleen during pregnancy can lead to a low platelet count.
- Immune disorders: ITP is linked to other conditions such as HIV, hepatitis C, H. pylori, or leukemia.
ITP Diagnosis
Diagnosing idiopathic thrombocytopenic purpura is a process of exclusion. First, a doctor will make sure that a low platelet count is the only blood abnormality present. Next, underlying illnesses that affect bleeding, such as leukemia and HIV are checked for.
A complete blood count (CDC) test is done to measure white and red blood cells and platelets. Another diagnostic blood test is the blood smear, which examines the platelet count of a blood sample under a microscope. Finally, a bone marrow biopsy is performed to evaluate the production of megakaryocytes which are platelet-forming cells.
ITP Treatment
Treatment begins with steroid medications such as corticosteroids or prednisone. Steroids are used to raise platelet count, but unfortunately, they cannot be used for a long duration. Therefore, the condition may return when treatment finishes.
In severe cases, surgical removal of the spleen is needed. A healthy spleen makes antibodies that aid in fighting infections. In patients with ITP, however, these antibodies are at fault for destroying platelets. Removing the spleen will decrease platelet destruction, but at the same time increase the risk for infections.
In rare, emergency cases when severe bleeding occurs, platelet transfusions are administered. Transfusions are also given before surgeries to help the incision heal. Transfusions are effective, but only a temporary fix.
