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IDIOPATHIC THROMBOCYTOPENIC PURPURA

Posted Jul 18 2010 8:50am

          I remember as a child, a friend of mine had a disorder called idiopathic thrombocytopenic purpura.  It sounded so awful and I thought she was really sick.  However, she had the acute form that disappeared and she was fine.  The blood disorder, referred to most commonly as ITP, is characterized by an abnormal decrease in the number of platelets in the blood.  Platelets are cells in the blood that help stop bleeding.  So, an individual with the disorder can have easy bruising, bleeding gums and internal bleeding.  Idiopathic actually means the cause is unknown.  Thrombocytopenia simply means a decreased number of platelets in the blood and purpura is the purple discoloring of the skin, as with a bruise.  Normal platelet count is in the range of 150,000 to 450,000.  With ITP, the platelet count is less than 100,000.  By the time significant bleeding occurs, the individual may have a platelet count of less than 10,000.   

          Acute thrombocytopenic purpura is usually seen in young children (2-6 years of age) and the symptoms can follow a viral illness with a sudden onset.  It is the most common form of the disease.  The disorder usually does not recur.  Scientists believe that the body, when making antibodies against a virus, also makes an antibody that can stick to the platelets and destroys them.  That is why ITP is also referred to as immune thrombocytopenic purpura.  In the chronic form (less common), the onset can happen at any age and the symptoms can last anywhere from 6 months to several years.  Adults have this form more often than children and females are 2-3 times more likely to have it than males.  Chronic ITP can recur often and requires continual follow-up with a hematologist.

          Symptoms of ITP are related to bleeding and the lower the platelet count, the greater risk for bleeding.  Everyone is slightly different in the way symptoms are displayed, but the most common signs of the disorder include petechia (tiny red dots under the skin because of very small bleeds), nosebleeds, purpura (the purple color of the skin after blood has leaked under it), bleeding in the mouth or around the gums, blood in the vomit, urine or stool and bleeding in the head.  Any head trauma that occurs when there are not enough platelets to stop the bleeding can be life threatening.  The parents of a child with the disorder need to be aware of how to prevent injuries and bleeding.  Be certain that he environment is as safe as possible.  Things like padding a crib, wearing helmets and providing protective clothing are necessary when platelet counts are low.  Further, contact sports and rough play may need to be restricted.  It is also necessary that you avoid medications that contain aspirin, as these may interfere with the body’s ability to control bleeding.

          Because most children recover with no treatment, many doctors recommend just watching them carefully and taking care of the bleeding symptoms.  Children don’t have to go to the hospital if good care is available at home.  However, some doctors recommend a short treatment with prednisone pills or intravenous infusions (given in a vein) of gamma globulin to increase the platelet count more quickly.  Treatment of ITP in adults is aimed at increasing the blood platelet count.  This is not the same as curing the disease.  Your doctor may recommend that you get high doses of immune globulin (through a needle). Some patients might take prednisone for several weeks or months.  Prednisone raises the level of your platelet count.  If prednisone doesn’t help enough, your doctor may recommend that your spleen be removed.  The spleen makes most of the antibodies that destroy the blood platelets.  It also destroys old or damaged blood cells.

          For most children and adults, ITP isn’t a serious or life-threatening condition.  Acute ITP in children often goes away on its own within a few weeks or months and doesn’t return.  In 80 percent of children who have ITP, the platelet count returns to normal within 6 to 12 months.  Treatment may not be needed.  A small number of children, about 5 percent, whose ITP doesn’t go away on its own may need to have further medical or surgical treatment.  Chronic ITP will vary with each individual and can last for many years. Even people who have severe forms of chronic ITP can live for decades.  Most people who have chronic ITP are able at some point to stop treatment and keep a safe platelet count.

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