Platelet Disorder - Immune Thrombocytopenia (ITP)

Immune thrombocytopenia (ITP) is a condition where the immune system attacks the body’s platelets and destroys them. The condition is triggered in adults with infections, such as HIV, hepatitis, or H. pylori.

The immune system malfunction can be due to the following factors:

• Certain medications cause allergic reactions that cross-react with platelets
• Viral infections, such as chicken pox, hepatitis, and HIV/AIDS
• Pregnancy
• Dehydration
• Trauma
• Autoimmune disorders, such as lupus and rheumatoid arthritis
• Lymphomas and leukemias

The symptoms of immune thrombocytopenia (ITP) are decreased platelet count, mostly related to increased bleeding. The lower the platelet count, the higher the risk of bleeding.

Symptoms of immune thrombocytopenia include:

• A bruise under the skin changes the skin color
• Nose and gum bleeding
• Severe menstrual bleeding
• Blood in vomit, urine, and stools

Your healthcare provider will do a physical examination and ask for the symptoms and history of medications. The doctor may advise the following tests:

• Complete blood count tests (to know platelet counts and confirm the diagnosis)
• A careful review of medicines
• Electrolyte levels
• Antiplatelet antibody test
  • If the antiplatelet antibody test is negative, a bone marrow aspiration test is done to know the platelet production and rule out any abnormal cells in the bone marrow that may result in lower production of platelets.

The treatment of immune thrombocytopenia (ITP) is based on the following factors:

• Age
• Overall health
• The number of platelets
• The severity of bleeding
• Underlying health conditions
• The extent of the disease
• History of medications you are taking

The treatment options include mainly steroids and intravenous gamma globulin.

• Steroids: High doses of dexamethasone, prednisone, and methylprednisolone are typically the mainstay of initial therapy. Steroids reduce platelet destruction and prevent bleeding. Steroids may increase the number of platelets in two to three weeks. The side effects are irritability, stomach irritation, increased blood pressure, acne, and weight gain.
• Intravenous gamma globulin: Contains multiple antibodies that help slow down platelet destruction. Works more effectively and faster than steroids and within 24 to 48 hours.

Other treatment options for ITP include:

• Rh immune globulin stops the spleen from destructing platelets temporarily. Effectively works only in those with Rh-positive blood type.
• If the condition is suspected to be caused by a specific drug, a change in medication, or discontinuation of the medicine is required.
• Treating the infection that caused ITP.
• Splenectomy prevents platelet reduction. Commonly recommended in chronic ITP to minimize the risk of platelet destruction.
• Platelet transfusion for people with severe bleeding.
• The FDA approved Promacta (eltrombopag) and Nplate (romiplostim) in 2008 to treat both children and adults diagnosed with ITP who had a poor response to immunoglobulins, corticosteroids, or splenectomy. Romiplostim is usually administered as a weekly subcutaneous injection in a doctor's office.