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.