Articles / Journals
Wyszynski, Diego F., Wendy J. Carman, Alan B. Cantor, John M. Graham, Liza H. Kunz, Anne M. Slavotinek, Russell S. Kirby, and John Seeger. “Pregnancy and birth outcomes among women with idiopathic thrombocytopenic purpura.” Journal of pregnancy 2016 (2016). Accessed from Hindawi.com
Thrombocytopenia – Why is my platelet count low?
Thrombotic Thrombocytopenia: A patient’s journey
Idiopathic/Immune Thrombocytopenia (ITP)
Idiopathic/Immune Thrombocytopenia (ITP) is a hematological disorder of the platelets leading to easy and excessive bruising and bleeding (even internal). The bleeding stems from low platelet counts where the causes may be unexplained. Hence, the term idiopathic. ITP causes bruises like a pinkish-purplish rash.
ITP can occur in children as well as adults. For reasons unknown, ITP affects more women than men. ITP occurs when the immune system suddenly produces antibodies against platelets. These antibodies attach to the platelets and the body starts attacking the antibodies along with the platelets. This leads to a destruction of platelets as well causing low counts.
In adults, this immune system reaction may be triggered by infections such as HIV, Hepatitis and H.pylori. In children, it may be simple viral fevers or measles/chickenpox.
There are two types of ITP:
- Acute thrombocytopenia – commonly seen in younger children (2-6 years of age). The symptoms usually appear after a viral infection like measles or chickenpox. Acute ITP occurs suddenly and symptoms usually disappear in about six months. The symptoms do not usually recur.
- Chronic thrombocytopenia – happens at any age and mostly in adults. Females are three times more likely than males to develop chronic ITP. Chronic ITP requires treatment and long-term follow up with hematologists.
Some common symptoms are:
- Tiny pinkish-purplish rash type of skin spots usually on the lower limbs
- Easy or excessive bruising. Even a slight pressure may lead to bleeding under the skin
- Bleeding from the nose and gums
- Blood in urine or stools
- Excessive menstrual bleeding
It is important to take these symptoms seriously and seek immediate medical attention. Internal bleeding which goes undiagnosed (like brain or gastrointestinal bleeds) may often turn fatal. If you experience any of the above symptoms, consult your physician as soon as possible. Do not IGNORE these symptoms.
- Complete blood count (CBC) to check the level of the platelets and look for morphological changes in the blood
- Blood tests to determine bleeding and clotting time
- A bone marrow aspiration to examine the production of platelets and rule out other hematological malignancies
Currently, no cure is available for ITP. It can be managed and symptoms may go away with time. In children, the condition usually goes away without any treatment, though some children may need treatment.
Adults usually need steroids called prednisone. In some cases, splenectomy (removal of the spleen) is needed to increase and stabilize platelet counts. Other drugs and therapies include:
- Danazol (Danocrine)
- Infusion of high-dose gamma globulin (an immune factor)
- Immunosuppressive drugs like rituximab
- Anti-RhD therapy for people of certain blood types
- Drugs like romiplostim (Nplate) or eltrombopag (Promacta) to stimulate platelet production in the bone marrow
Children and adults with ITP must be encouraged to participate in all life activities and must be encouraged to go to regular schools, colleges and participate in social activities to the extent possible. As long as children and adults maintain their platelet counts and stick to the medication regimen, they can do everything that a normal individual does. Always carry your medications with you to school, college, work, travel and outdoors. Know your body and learn to pick up even slight bleeds. Take medical action whenever required without delay.
Psychosocial counselling must be made available whenever required with other supportive measures.
According to a study by Wyszynkski et al., 2016, chronic ITP is linked to adverse pregnancy outcomes like preterm birth, elective and spontaneous loss and major congenital anomalies. Results suggested that women diagnosed with ITP prior to pregnancy were at a higher risk of delivering stillborns. The study followed 446 pregnancies with ITP of which 346 resulted in live births. 7.8% of all these live births presented with major congenital anomalies like heart defects. 15.2% of all these live births were preterm, premature babies.
If you have ITP and get pregnant, make sure you get high-risk pregnancy care throughout the gestation period. Avoid hard, physical activity during this period. Do not take any extra medication without consulting your gynecologist and primary physician.