What is ITP?


ITP or immune thrombocytopenia can be difficult to diagnose and treat, particularly in the adult population. As recognized by experts like Hematologist in Lahore this disorder is triggered by a viral or bacterial infection, both in adults and children. While the latter recover quickly, it is the adult population in which the disorder is often long term. Read on to know more about immune thrombocytopenia:

What is immune thrombocytopenia?

As the name implies, ITP is an immune disorder whereby the body’s defense mechanism destroys the cells in the blood responsible for preventing bleeding and initiating clotting. Consequently, in case of mild trauma or injury, there is excessive bleeding—both internally and externally, along with excessive bruising on and under the skin. These bruises are often called purpura. Previously, immune thrombocytopenia was called ‘idiopathic thrombocytopenic purpura’ because of the presence of these purpura.

Although it can occur at any age, immune thrombocytopenia is more common in adults over the age of 60 years. Almost 40 percent of all cases of ITP occur in children between the ages of two and four years—following viral infections like chickenpox, measles and mumps.

What are the types of immune thrombocytopenia?

The two subtypes of immune thrombocytopenia are:

  • Acute immune thrombocytopenia: this type lasts less than six months and is more common in children. 9 out of 10 cases of ITP are acute in type, and go away on their own. In comparison to its chronic counterpart, the acute type occurs short term.

  • Chronic immune thrombocytopenia: this subtype is more common in adults and lasts more than six months.

What are the causes of immune thrombocytopenia?

Immune thrombocytopenia occurs when the body’s antibodies or fighter cells recognize the body’s own platelets as ‘foreign’ and attack them. The destruction of these platelets causes bleeding tendencies as these cells are important for the sealing and healing of wounds. In the absence of platelets, wounds take longer time to stop bleeding.

The exact cause of immune thrombocytopenia is not known. However, as mentioned before, viral and bacterial infections often act as triggers of immune thrombocytopenia. Other triggers of secondary immune thrombocytopenia include:

  • Concurrent autoimmune disorders like SLE

  • Cancers including chronic lymphocytic leukemia (CLL)

  • Trauma

  • Sepsis

  • Pregnancy

  • Dehydration

  • Medication such as aspirin and ibuprofen

  • Chronic infections

What are the symptoms of immune thrombocytopenia?

The normal platelet count of the body is between 150,000 and 400,000 per milliliter of blood. This count drops to less than 20,000 in immune thrombocytopenia.

If the disease is mild, the patient may not present with overt symptoms. However, if the platelet count drops very low there may be increased bleeding and bruising. Symptoms of immune thrombocytopenia, include:

  • Frequent nosebleeds

  • Easy bruising of skin

  • Bleeding from gums

  • Internal bleeding particularly in the joint space

  • Small red dots on the skin (petechiae) that appear rash-like

  • Blood in the urine

  • Blood in the stool

  • Profuse bleeding in case of surgery

  • Heavy menstruation

How is immune thrombocytopenia diagnosed?

Immune thrombocytopenia diagnosis starts with a complete history and physical examination. In addition, the following investigations are performed:

  • Complete blood count (CBC)

  • Platelet antibody levels

  • Electrolyte levels

  • Liver function tests

  • Kidney function tests

  • Blood smear

  • Bone marrow biopsy

  • Other tests: to rule out other conditions like aplastic anemia and acute leukemia.

Who is at risk of immune thrombocytopenia?

The incidence of immune thrombocytopenia is higher in women as they suffer more from chronic autoimmune disorders. The risk is also high in people with concurrent disorders like antiphospholipid syndrome, lupus (SLE) and rheumatoid arthritis (RA)

What are the complications of immune thrombocytopenia?

Immune thrombocytopenia predisposes the patient to internal bleeding and this is particularly dangerous if occurs in the brain. Intracranial bleed can prove fatal in such conditions. Pregnant women with immune thrombocytopenia also risk bleeding heavily at the time of delivery. Depending on the severity of disease the healthcare expert like Hematologist in Karachi may recommend stable platelet count.

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