Causative & risk factors
The exact cause of Idiopathic thrombocytopenic purpura is not known, but it is known that in this condition the immune system produce antibodies against platelets and these antibodies attack the platelets, as if the platelets were foreign substances.
The antibodies get attached to the platelets, and the spleen removes the platelets which carry the antibodies from your system resulting in lower number of platelets.
Sometimes in children, the disorder follows a viral infection like mumps or flu. In adults it can follow viral infections or as an after-effect of certain drugs.
This disorder is more common in women than men and common in children than adults.
Clinical presentation
Patients with ITP may not have any symptoms, but if the symptoms do occur, they present as bleeding from several orifices. Superficial bleeding can occur into the skin, which appears like pinpoint reddish-purple spots known as petechiae. Purpura or excessive bruising tendency is present. Any cuts or wounds may bleed for a long time. Hematuria, epistaxis, bleeding gums or bleeding into the stools may be seen. Women with ITP may have abnormally heavy menstruation.
Investigations
Your doctor will perform a physical examination to look for signs of bleeding under the skin, and will review your medical history. A complete blood count and a peripheral blood smear exam is performed to check the platelet count. The partial thromboplastin time (PTT) and prothrombin time (PT) are measured. Bone marrow examination may be done to rule out diseases of the bone marrow.
Treatment
The treatment is focused on ensuring a safe platelet count and preventing the bleeding complications.
In children, the disorder usually goes away without treatment, within 6 months. In adults regular monitoring and platelet checks are required. If the symptoms are severe and the platelet count remains low, the doctor may recommend following treatment with medications or surgery.
Commonly used medications for ITP are corticosteroids. Newer drugs include the use of thrombopoietin receptor agonists and biologic agents like rituximab.
In severe cases where medications do not help, surgical removal of the spleen (splenectomy) is recommended.
Statistics
ITP occurs in approximately 5 in 100,000 children. Girls are thrice as likely to develop ITP compared to boys.
