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Idiopathic thrombocytopenic purpura is also called ITP. It is a bleeding disorder that stems from the immune system destroying all the body's platelets that are needed in clotting blood. There aren't enough platelets in the blood and there is bleeding from different areas of the body. Another name for ITP is immune thrombocytopenic purpura. The term "purpura" means bruising-a common phenomenon for those who have the disorder.
Causes of ITP are when the immune cells produce antibodies against platelets. Platelets normally plug holes in damaged blood vessels using other chemicals to help them. The antibodies destroy the platelets by attaching to them and allowing other immune cells to gobble up the platelets. The spleen also destroys the platelets that have antibodies in them. In children, infection with a virus usually precedes the development of ITP. Adults get ITP as well following a viral infection, a chronic disease, during pregnancy and because of the use of certain drugs. Autoimmune diseases can affect the development of ITP. ITP affects women more often than men and is more likely to occur in children than in adults. When it happens in children, boys are involved as frequently as girls.
The symptoms of idiopathic thrombocytopenic purpura include pinpoint petechiae on the skin, which are pinpoint red spots on the skin. Women have very heavy periods and bruising is a common phenomenon. Nose bleeds or mouth bleeding are also problems with ITP.
Examination and testing for ITP include lab tests, a thorough physical and history of the disease. Doctors look for bleeding sites, bruising and petechiae. They also ask about the history of the disease and whether or not the person had a preceding virus. A CBC will show a reduced number of platelets but a normal amount of red and white blood cells. The Protime and PTT are considered normal. Bleeding time is longer than is normal and platelet-associated antibodies can be found in the bloodstream. A bone marrow study shows a normal bone marrow but it may also show a greater number of megakaryocytes in the bone marrow. Megakaryocytes form platelets in the bone marrow and send them out to the blood stream. The spleen may be enlarged to the touch.
The treatment of ITP includes preventing bleeding by taking care of the body and applying treatment, if needed, in severe cases. Medications for ITP include corticosteroid medications to reduce the immune system functioning. A splenectomy may need to happen if the corticosteroids don't work and the spleen is enlarged. This improves ITP in about half of all cases. In the rest, only drug treatment will make a difference.
Other medications that work for ITP include Danazol or Danocrine, which blocks the immune system. Injections of a large amount of gamma globulin can prevent antibodies from forming on the platelets. Other immunosupressors are used to block the immune system. Doctors can filter antibodies out of the bloodstream and anti-RhD antibodies are given if a person has a certain blood type. Avoidance of aspirin, Coumadin and anti-inflammatory agents is necessary because these drugs can interfere with the functioning of platelets and can make bleeding worse.
The prognosis of people with ITP is actually good as long as the proper treatment is done. In rare cases, the disease becomes chronic and won't go into remission. In some cases, remission occurs but the person relapses into another episode of ITP.
Complications of ITP can be severe. There can be a sudden and severe bleeding from the stomach, oesophagus, intestine or colon. There can be bleeding into the brain, resulting in a haemorrhagic stroke or a subarachnoid haemorrhage or subdural haemorrhage. These can cause permanent brain damage.
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