ITP Idiopathic Thrombocytopenic Purpura

Idiopathic-Thrombocytopenic-PurpuraITP or Thrombocytopenic is a medical condition for low platelet count. The idiopathic portion means that the causation is not known. The purpura regfers to pin prick bleeding under the surface of skin, which is a symptom of  ITP.

Idiopathic means immune, or immune thromboctopenic purpura (ITP) antibodies covers the surface of the blood platelets. This destroys the blood platelets and causes their levels to drop.

There are two types of ITP:

1.  Acute ITP begins instantly, and starts after viral illness within a child. Acute ITP may not require treatment. This is especially true in cases where platelet counts don’t fall too low and there is little bleeding. In usually improves naturally, particularly in children and never returns.

2.Chronic ITP – develops over time. Chronic ITP last for a long time, usually more common in adults. Treatment is usually not needed in if platelet level is not at risk of bleeding. Factors within  a persons lifestyle will affect risk level, such as physical activity, sports, manual work, etc.

ITP in children and adultsChildAdult
Age most likely to occur (years)2-620-30
Gender ratio of disease (M:F)1:11:3
Start of diseaseacutesubtle
Preceding infectioncommonunusual
Platelet count (x 109/L)often <20often >20
Spontaneous remission rate (%>80<20
Usual duration2-4 weeksmonths-years

There are multiple treatments for ITP Idiopathic-Thrombocytopenic-Purpura

The initial treatments for acute and chronic ITP are very similar. There are a variety of agents that help to treat ITP, including infusions, steroids, immunoglobulin,  and on rare occasions anti-D .

Steroids are often given orally in the form or prdnisolone. In rare cases are intravenous steroids used to treat ITP. They are usually prescribed over several weeks or several months and the dosage are slowly reduced.

There are side effects to taking steriods

1. Facial puffiness or bloating

2. Increased appetite

3. Influences mood (depression, elation, vivid dreams)

4. Indigestion

5. weight gain

6. Suppression of immune response resulting in increased risk of infections.

WIth prolonged risked of steroids, the body could be exposed to risk of osteoporosis.

Within in Acute ITP, the patient often responds within three to four weeks of steroid treatment. after which treatment is suspended.

In Chronic ITP, there may be initial improvement, however platelet count will fall again after the dose of steroids are reduced or withdrawn. In these cases doctors will have to alternative treatments and if long-term low dosage of steroids are still administered, then measures to protect patient against osteoporosis must be developed.

Immunoglobulin are antibodies, that are made by the immune system, when the body is exposed to a foreign protein.

If the foreign proteins appears within the body again at a later time, it will be recognized and identified by the antibody, and it will activate the rest of the body immune system to fight against it, It can take the boday several days or weeks to make immunoglobulins to fight a foreign protein. But they can be pooled in from donated human blood, through injection.

Immunogloblin G (IgG)i s given intravenously over two to five days during treatment. The exact reactions caused by IgG are unknown, however, its thought to block stop platelet removal, increasing the number of blood platelets. IgG treatment is only effective as a temporary treatment., thus it’s used primarily in acute ITP. In chronic  ITP, the patient may recive a temporary rise in  platelets but it will not last, this is effective in cases of pregnancy since there is less risk to the baby, compared to other treatments

Anti-D antibody is an alternative approach to treatment. Anti-D contains antibodies to the rhesus blood group, with ‘D’ proteins. These treatment is delivered in much the same as IgG, through intravenously injections, but is administered in a single injection. Many treatment center are now offering  Anti-D as the preferred treatment because it is just as effective as IgG, yet simpler to administer to the patient.

There are other alternative treatments of immune suppression, in which drugs, such as: azathioprine,vincristine, mycophenolate, danazol,cyclophosphamide and cyclosporine a, are administered to the patient. It can take two to three months for drugs such as cyclophosphamide and azathioprine to bring up the platelet count. These treatments need to be carefully monitored as these drugs have toxic side effects that can effect liver functions.

Mycophenolate is a slow to effect ITP, side effects can include abnormal blood counts or low white blood cell levels and abnormal liver functions.

Danzol is a hormone like drug, that is a synthetic androgen. It’s successful  about 50% of the time used. The side effects can include weight gain, acne and increased body hair.

Cyclosporine can suppress certain parts of the immune system. This is often used in patients who have had a transplant to prevent rejection of an organ. Some individuals with chronic ITP have responded to this treatment

Other treatments have recently become available such using agents to increase the production of patelets by bone marrow, whereby it mimics to the action of the thrombopoietin. This hormone normally helps platelet production.

These forms of treatment can be very effective, however the patient must be closely monitored. Side effects of these rapid platelet production can cause predispose to thrombosis (blood clot formation).

Informed by Dr Claire Harrison, Consultant Haematologist, St Thomas’ Hospital, London and Professor Samuel Machin, Department of Haematology, University College London Hospital