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What is immune thrombocytopenic purpura?

Answered by
Dr.
Dr. Jyothi B L

Pathologist and Microbiologist

Practicing since :2003

Answered : 849 Questions

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Posted on Wed, 30 Jul 2014 in Blood Disorders
Question: Can you give me information about ITP? My grandson is being treated for it in XXXXXXX I understand this is when one's body attacks one's platelets. My grandson is undergoing four rounds of treatment which are large doses of steroids. He may have to have his spleen removed. Thank you for your help.
XXXXXXX
doctor
Answered by Dr. Jyothi B L 1 hour later
Brief Answer:
ITP is autoimmune disorder, bleeding manifestation

Detailed Answer:
Hi

I am Dr Jyothi BL. As a qualified expert in the field of pathology and hematology I would like to take up your query.

Immune thrombocytopenic purpura(ITP) is an autoimmune disorder with bleeding manifestations in which auto antibodies bind to platelets and remove them from circulation. As a reasult platelet count is decreased.

In prepubertal children the peak age of incidence is 2 to 4 years, boys and girls are equally affected. Possible cause is a viral infection preceding the onset of ITP.

There are two types: acute ITP and chronic ITP.
Acute lasts for less than 6 months, most common in children usually resolves spontaneously. However in 7 to 28 percent cases it progresses to chronic ITP. Chronic lasts for more than 6months, requires therapy to improve platelet count and seen mostly in adults. Based on the details provided,
your grandson it appears to be acute ITP.

Bleeding manifestations can be dry purpura ( only skin bleeds) or wet purpura( involves mucous membrane also). Complications are high with wet purpura. Your treating doctor should screen those purpura's if any.

Generally frequency and severity of bleeding manifestations correlate with platelet counts. Therefore treating doctors should keep his platelet counts monitored.

Childhood ITP is benign and self limited, treatment required in case of severe thrombocytopenia( less than 20000/micro l) and bleeding or who remain thrombocytopenic for more than 6months. So do not be very concerned. Steroids cause a prompt increase in platelets and hence I glad he is already on it. If it doesn't help, the other options are Anti CD20 antibody. The last resort is splenectomy. You can discuss about anti CD20 antibodies with the treating doctor in case steroids fail to help.
Splenectomy is usually reserved for those not responding to steroids or there is a relapse during steroid therapy.

Hope I have answered your query, any further queries would be glad to help again
Regards.
Dr Jyothi BL
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Jyothi B L 9 hours later
My grandson's platelet count was down to 11 before treatment. I understand that when the count gets down to 10, internal bleeding begins. My grandson has had mysterious rashes since he was very small. The first time occurred when he was 3 years old. Could these have been connected to the ITP he's now experiencing?
doctor
Answered by Dr. Jyothi B L 7 hours later
Brief Answer:
Not connected to mysterious rashes

Detailed Answer:
Hi XXXXXXX
Based on your query, I can give my comment as follows:

1. Platelet Count below 10,000/cumm (I hope we are talking about the same units of measurement) has an increased risk of internal bleeding and does not mean, it should necessarily bleed. For bleeding to occur even internally, there should be breakdown of blood vessels. If he takes absolute rest during that period, the risk of internal bleeding is really low.

2. In ITP,the preceding viral infections is most of the times 3-4 weeks old. So, those mysterious rashes could not be the cause.

3. If this is the first episode of ITP, it cannot be possibly connected.

4. Those mysterious rashes, caused due to any viral infection and it may not be related to ITP. It would not be such a late manifestation.

5. However, I should caution you that if this is the first episode of acute ITP at this age, a small chance is present where it can progress to chronic ITP.

Any further queries, happy to help again.
Dr. Jyothi BL

Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Jyothi B L 2 hours later
My son reported tonight that my grandson's platelet count is up in the 90s as of today. My grandson will be a XXXXXXX at Stanford next fall and has just begun his summer internship in XXXXXXX at Bose. He went to work today, but started getting shaky and antsy. He just completed the four rounds of steroid treatments today. I hope and pray this is the end. Once a person has had ITP, will it raise its nasty head again sometime in the future?
doctor
Answered by Dr. Jyothi B L 58 minutes later
Brief Answer:
Increasing platelet count - good prognosis

Detailed Answer:
Hi XXXXXXX
Good to know the platelet count is in the 90s. He is probably tensed with all these investigations, diagnosis and treatment and will be shaky for some time.

ITP in adults is variable depending on the severity of symptoms and response to therapy. As the platelet count is improving, it definitely signifies good prognosis.

However, there is small chance of an acute ITP going to chronic ITP. Do ask him to keep watch for any skin / mucosal bleeds for the next six months.

Any further queries, happy to help again.
If you do not have any further queries, you can close the discussion and rate the answer.
Thanks for asking.
Dr. Jyothi BL
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Jyothi B L 4 hours later
Thank you so much, Dr. Jyoth. I learned so much from you. I appreciate your help so much.

Blessings,
XXXXXXX
doctor
Answered by Dr. Jyothi B L 1 hour later
Brief Answer:
Welcome

Detailed Answer:
Hi XXXXXXX
You are welcome. Hope I have clarified your queries. If you don't have any further queries you can close the discussion and rate the answer. Wish your grandson good health.
Regards
Dr Jyothi BL
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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