Immune Thrombocytopenic Purpura (ITP): Types, Symptoms, and Treatment

What is Immune Thrombocytopenic Purpura (ITP)?

Immune Thrombocytopenic Purpura (ITP) is a condition where the body's immune system mistakenly attacks and destroys its own blood clotting cells called platelets. This can lead to easy bruising and bleeding. 

Other Names for ITP

• Autoimmune thrombocytopenic purpura.
• Idiopathic thrombocytopenic purpura.
• Autoimmune thrombocytopenia.
• Werlhof disease.

Types of Immune Thrombocytopenic Purpura (ITP)

There are two types of ITP:

• Primary ITP: In this type, the immune system targets and attacks platelets. Approximately 80% of all ITP cases are categorised as primary ITP. Healthcare professionals often refer to this condition as an autoimmune disorder.
• Secondary ITP: This type may develop if there are underlying conditions, such as chronic infections, blood cancers, or autoimmune disorders, affecting platelet levels.

ITP is also classified based on the duration of the condition:

• Acute ITP: Typically, acute immune thrombocytopenia resolves within three months. It is more commonly observed in children than in adults.
• Persistent ITP: This form of ITP disease lasts between three and 12 months.
• Chronic ITP: Chronic ITP persists for a year or longer.

Symptoms of Immune Thrombocytopenic Purpura (ITP)

Immune thrombocytopenia (ITP) disease can present with a wide range of symptoms or, in some cases, no symptoms at all, making it difficult to diagnose.

Easy Bruising

ITP can lead to easy bruising, even with minor injuries. This occurs because a reduced platelet count impairs the blood's ability to form clots effectively.

Petechiae

One symptom of ITP is the presence of tiny reddish-purple spots in the skin, known as petechiae. These spots are most commonly seen on the lower legs and can resemble a rash. They develop due to minor blood vessels bleeding under the skin.

Purpura

In more severe cases, people may notice larger areas of bleeding into the skin, referred to as purpura. Purpura typically appears as more significant, dark patches on the skin caused by increased blood vessel leakage.

Bleeding from Gums or Nose

People with ITP may experience bleeding from the gums or nose, often with no apparent cause. A low platelet count can compromise the blood vessels' ability to withstand even minor trauma.

Blood in Urine or Stools

In some instances, ITP can lead to blood appearing in urine or stools. This symptom should be taken seriously, and immediate medical attention is necessary to determine the underlying cause.

Heavy Menstrual Flow

For female patients with ITP, a hefty menstrual flow can be a noticeable symptom. The reduced platelet count can affect the blood's clotting ability during menstruation, leading to heavier bleeding.

Causes of Immune Thrombocytopenic Purpura (ITP)

ITP, or Immune Thrombocytopenia, is a non-contagious blood disorder. It cannot be transmitted from one person to another. This condition can be categorised as primary, occurring independently, or secondary, triggered by other underlying conditions.

Possible triggers for secondary ITP include:

• Other autoimmune diseases.
• Chronic infections.
• Certain medications, such as ibuprofen or aspirin.
• Dehydration
• Trauma
• Pregnancy
• Certain types of cancer.

ITP is often called "idiopathic," meaning it has no known cause. This is because the condition is not hereditary, and there is no apparent predisposition for primary ITP.

Diagnosis of Immune Thrombocytopenic Purpura (ITP)

Diagnosing Idiopathic Thrombocytopenic Purpura (ITP) involves a few steps because there isn't a specific test that can definitively diagnose the condition. Instead, doctors use a combination of medical history, physical examination, and lab tests to diagnose. 

Medical History

• Symptoms: The doctor will ask about any signs of bleeding or bruising, as well as other symptoms that might suggest a low platelet count.
• Recent Illnesses: A discussion of any recent illnesses or infections, since a viral infection often precedes ITP in children.
• Medications: Information about any medications being taken, as certain drugs can cause low platelet counts.

Physical Examination

• Looking for Bruises and Petechiae: The doctor will check the skin for signs of bruising or petechiae (small red or purple dots caused by bleeding under the skin).
• Checking the Spleen: The spleen might be examined, as an enlarged spleen can be associated with low platelet counts.

Blood Tests

• Complete Blood Count (CBC): This is the primary test for diagnosing ITP. It measures the number of platelets in a blood sample. In ITP, the platelet count is usually low.
• Blood Smear: A blood sample is examined under a microscope to look at the platelets and other blood cells.
• Other Tests: Depending on the situation, additional blood tests might be done to rule out other conditions that can cause low platelet counts.

Bone Marrow Examination

This test is more common in adults than in children. A small sample of bone marrow (the spongy tissue inside bones where blood cells are made) is taken and examined to rule out other diseases that might be causing low platelet counts.

Treatment for Immune Thrombocytopenic Purpura (ITP)

The treatment choice for ITP is based on several factors, including the patient's platelet count, the frequency and severity of bleeding, and individual characteristics. Here's a summary of the treatment options mentioned:

Observation

In some cases, especially with mild or acute ITP in children, treatment may not be necessary as the condition can improve on its own.

Medications

If treatment is required, medications are often the first line of therapy. The following medications may be used:

• Corticosteroids: Such as prednisone, can repress the immune system's activity and increase platelet counts.
• Intravenous Immunoglobulin (IVIg): Used in critical situations or before surgery to rapidly increase platelet counts.
• Anti-D Immunoglobulin: For Rh-positive individuals, this can also increase platelet counts quickly, but it has potential side effects.
• Rituximab: An antibody therapy that targets B cells responsible for producing proteins that attack platelets. It may reduce platelet destruction, but its long-term benefits are unclear.
• Thrombopoietin Receptor Agonists: Medications such as romiplostim and eltrombopag are FDA-approved for chronic ITP treatment by stimulating platelet production in the bone marrow.
• Antibiotics: In some cases, when Helicobacter pylori infection is associated with ITP, antibiotic therapy may eliminate the infection and potentially increase platelet counts. However, this approach is still under investigation.

Surgery (Splenectomy)

In cases of severe ITP that do not respond to medications or other treatments, a splenectomy may be considered. A splenectomy involves the surgical removal of the spleen. The spleen is where platelets can be sequestered and destroyed, so removing it can help increase platelet counts. However, this procedure is usually reserved for adults with severe ITP as children often experience spontaneous remission, and splenectomy can increase the risk of certain bacterial infections in the future.

Emergency Treatment

Severe or widespread ITP can be a medical emergency due to the risk of life-threatening bleeding. Emergency treatments may include transfusions of concentrated platelets and the intravenous administration of corticosteroids (e.g., methylprednisolone), IVIg, or anti-D treatments to increase platelet counts and control bleeding rapidly.

Lifestyle Changes

Patients with ITP may be advised to make certain lifestyle modifications to ease the risk of bleeding and improve their overall health. These changes may include:

• Avoiding certain over-the-counter drugs that can affect platelet function, such as aspirin, ibuprofen, and blood-thinning medications like warfarin.
• Limiting alcohol intake, as excessive alcohol consumption can adversely affect blood clotting.
• Choosing low-impact activities over competitive or high-impact sports to decrease the risk of injury and bleeding.

Treatment for ITP During Pregnancy

Treatment for women with ITP during pregnancy depends on their platelet count. Those with mild ITP cases typically require no treatment apart from vigilant monitoring and routine blood tests.

However, for women with an exceedingly low platelet count late in pregnancy, there is an elevated risk of substantial and severe bleeding during and after childbirth. In such instances, the attending physician will collaborate with the women to establish a treatment strategy aimed at sustaining a safe platelet count while safeguarding the well-being of the baby.

Women who experience ITP concurrently with other significant pregnancy-related conditions, such as preeclampsia, will require treatment as well.

While the majority of infants born to mothers with ITP are unaffected by the disorder, some may be born with or develop a low platelet count shortly after birth. Babies with severely diminished platelet counts may necessitate treatment.

Final Words

At Max Hospital, we offer personalised care and advanced treatments for immune thrombocytopenia (ITP). Our diagnosis process includes a medical history review and blood tests. Treatment options range from medication and antibody therapy to splenectomy in severe cases. In emergencies, our swift and effective care is your solution. We also guide lifestyle changes and tailored pregnancy management. Your well-being is our top priority.