ITP (Immune Thrombocytopenia) is a rare bleeding disorder that affects the blood's ability to clot. In ITP, the immune system mistakenly attacks and destroys platelets, which are responsible for clotting blood. This condition can result in spontaneous bleeding, bruising, and prolonged bleeding after an injury or surgery. ITP can affect people of all ages, but it is most commonly diagnosed in children and young adults. In this article, we will discuss the causes, symptoms, diagnosis, and treatment of ITP.
Causes of ITP
The exact cause of ITP is not fully understood. However, it is believed that the immune system plays a significant role in the development of the condition. In ITP, the immune system mistakenly recognizes platelets as foreign and produces antibodies that attack and destroy them. This can result in a low platelet count and impaired clotting ability.
In some cases, ITP can be triggered by an infection or a viral illness. The immune system response to the infection can also mistakenly attack platelets. ITP can also be associated with other autoimmune disorders, such as lupus, rheumatoid arthritis, or antiphospholipid syndrome. In rare cases, ITP can be a side effect of certain medications, such as heparin or quinine.
Symptoms of ITP
The symptoms of ITP can vary depending on the severity of the condition. Some people may not experience any symptoms, while others may have severe bleeding episodes. Common symptoms of ITP include:
Easy bruising: People with ITP may develop bruises on their skin without any apparent injury.
Petechiae: These are small red or purple spots that appear on the skin, particularly on the legs and feet.
Prolonged bleeding: People with ITP may experience prolonged bleeding after an injury or surgery.
Gum bleeding: Bleeding gums can occur during brushing or flossing.
Nosebleeds: Frequent or prolonged nosebleeds can be a symptom of ITP.
Heavy menstrual periods: Women with ITP may experience heavier than normal menstrual periods.
Diagnosis of ITP
The diagnosis of ITP begins with a physical exam and medical history. The healthcare provider will look for signs of bleeding, such as bruising or petechiae, and ask about any medications or medical conditions that could be causing the symptoms.
Blood tests are an essential part of the diagnostic process for ITP. The blood tests will include a complete blood count (CBC) to measure the number of platelets in the blood. If the platelet count is low, the healthcare provider may order additional tests to determine the cause of the low platelet count, such as antibody tests or a bone marrow biopsy.
Treatment of ITP
The treatment of ITP depends on the severity of the condition and the symptoms experienced by the patient. In some cases, people with ITP may not require any treatment, as the condition may resolve on its own. However, people with severe bleeding episodes or low platelet counts may require treatment to manage the condition.
Corticosteroids
Corticosteroids are often the first-line treatment for ITP. These medications can reduce inflammation and suppress the immune system's response, which can help prevent the destruction of platelets. Corticosteroids are usually given as a short-term treatment to increase the platelet count quickly. The most commonly used corticosteroid for ITP is prednisone, which is given orally. Other corticosteroids, such as dexamethasone, may also be used.
Corticosteroids can cause side effects, such as weight gain, high blood sugar, and mood changes. The healthcare provider will monitor the patient closely for any adverse effects of the medication.
Intravenous Immunoglobulin (IVIG)
Intravenous immunoglobulin (IVIG) is another treatment option for ITP. IVIG is a solution of antibodies derived from donated blood. These antibodies can bind to the immune system cells that are attacking platelets, preventing further destruction of platelets. IVIG is usually given as an infusion into a vein, and the treatment can take several hours.
IVIG can be an effective treatment for ITP, and the platelet count can increase within a few days of the infusion. However, IVIG is an expensive treatment, and it can cause side effects, such as headache, fever, and chills.
Rituximab
Rituximab is a medication that targets the B cells in the immune system, which produce the antibodies that attack platelets. By targeting these cells, rituximab can reduce the destruction of platelets and increase the platelet count. Rituximab is usually given as an infusion into a vein.
Rituximab can be an effective treatment for ITP, particularly in people who have not responded to other treatments. However, rituximab can cause side effects, such as infusion reactions, infections, and a low white blood cell count.
Thrombopoietin Receptor Agonists
Thrombopoietin receptor agonists are medications that stimulate the production of platelets in the bone marrow. These medications can be effective in increasing the platelet count in people with ITP. Thrombopoietin receptor agonists are usually given as an oral medication, and the treatment can take several weeks to see the full effect.
The most commonly used thrombopoietin receptor agonist for ITP is eltrombopag, which can be effective in increasing the platelet count in up to 60% of people with ITP. However, thrombopoietin receptor agonists can cause side effects, such as headache, nausea, and fatigue.
Splenectomy
Splenectomy is a surgical procedure that involves removing the spleen. The spleen is an organ that filters the blood and removes damaged or old blood cells, including platelets. By removing the spleen, the destruction of platelets can be reduced, and the platelet count can increase.
Splenectomy is usually considered as a treatment option for people with severe ITP who have not responded to other treatments. However, splenectomy can increase the risk of infection, particularly with encapsulated bacteria, such as Streptococcus pneumoniae. Therefore, people who have had a splenectomy are often recommended to receive vaccinations to reduce the risk of infection.
Dr. A. Arrazaghi. MD,FRCPC