What are the other Names for this Condition? (Also known as/Synonyms)

• Autoimmune Thrombocytopenic Purpura
• Idiopathic Immune Thrombocytopenia
• Immune Thrombocytopenic Purpura (ITP)

What is Immune Thrombocytopenia? (Definition/Background Information)

• Immune Thrombocytopenia describes a common condition that results in decreased number of platelets in blood. It is caused by an abnormal immune system resulting in the destruction of platelets circulating in the body
• The platelets are a type of blood cells that help in clotting. Immune Thrombocytopenia can cause spontaneous bleeding, excessive bleeding in response to a mild injury, red or purple spots on skin, and a propensity to bruising
• Immune Thrombocytopenia can affect children and adults and may be categorized as acute or chronic:
  • Acute Immune Thrombocytopenia is usually observed in children and lasts for a short period of 6 months or less. The onset of the condition, in many cases, is following a viral infection. It is normally self-resolving and may not require any treatment
  • Chronic Immune Thrombocytopenia may be sometimes seen in adolescents and teens, but is more common in adults. It is present for a period of 6 months or more, sometimes for several years
• The diagnosis of Immune Thrombocytopenia may involve physical exams, blood tests (such as complete blood count, peripheral blood smear, and clotting time), and tests to diagnose an underlying infection, if any present
• The treatment options for Immune Thrombocytopenia depend upon the severity of the symptoms. Asymptotic and mild episodes may not require any treatment. Severe cases of bleeding may require the administration of suitable medication and transfusion of platelets
• The prognosis depends on the type of the condition and severity of the signs and symptoms. In many children with acute Immune Thrombocytopenia, the condition is usually self-limited. In adults with chronic Immune Thrombocytopenia, the condition can last for many years

Who gets Immune Thrombocytopenia? (Age and Sex Distribution)

• Immune Thrombocytopenia is a common condition that can affect individuals of any age; both children and adults may be affected
  • The acute form of Immune Thrombocytopenia affects children more than adults
  • The chronic form of Immune Thrombocytopenia is usually seen in adults, though older children and teens are also at risk
• Both male and female gender are affected
  • The acute form affects both males and females equally
  • The chronic form is seen more often in females (female-male ratio is 2:1 to 3:1)
• There is no racial or ethnic group bias observed

What are the Risk Factors for Immune Thrombocytopenia? (Predisposing Factors)

The following are the risk factors for Immune Thrombocytopenia:

• Genetic predisposition
• Viral infections that include:
  • Mononucleosis
  • Cytomegalovirus (CMV) infection
  • HIV infection or AIDS
  • Hepatitis infection
• Bacterial infection caused by Helicobacter pylori

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Immune Thrombocytopenia? (Etiology)

In a majority of cases, Immune Thrombocytopenia is believed to be the result of an autoimmune response, where antibodies of the body that fight diseases or infections, attack one’s own healthy tissues instead. Such an attack by the body’s immune cells against its own tissue can result in significant signs and symptoms

• The condition leads to an increased rate of destruction of platelets in the bloodstream (causing thrombocytopenia)
• The triggering factors of Immune Thrombocytopenia may include certain bacterial and viral infections
  • In children with acute Immune Thrombocytopenia, the condition develops immediately following a viral infection, in many cases
  • In adults, chronic Immune Thrombocytopenia is associated with infections caused by certain bacteria and virus
• Some individuals have an increased risk for the condition owing to certain genetic factors

What are the Signs and Symptoms of Immune Thrombocytopenia?

The signs and symptoms of Immune Thrombocytopenia may vary from one individual to another. It may be asymptomatic, mild, or severe. The signs and symptoms may include:

• Red or purple spots in the body (called petechiae), particularly on the lower legs
• Tendency for bruising
• Presence of blood in the urine and stool
• Bleeding under the skin forming lumps, called hematoma
• Spontaneous and extensive bleeding
• Excessive and unusual bleeding from the nose (nosebleeds) and mouth (bleeding from the gums)
• Bleeding from the rectum
• Unusual level of bleeding after surgery
• Abnormally heavy menstrual bleeding in females
• Fatigue

How is Immune Thrombocytopenia Diagnosed?

The diagnosis of Immune Thrombocytopenia may involve:

• A thorough physical examination and an assessment of the signs and symptoms
• A detailed evaluation of the individual’s medical history to get information on the following:
  • Medicines that are currently being taken including chemotherapy medication
  • Whether the beverages the individual takes contain quinine
  • General eating habits
  • Alcohol consumption
  • Risk for HIV infection or AIDS via blood transfusions, multiple sexual partners, and use of intravenous drugs
  • Recent history of viral or bacterial illnesses
• Blood tests:
  • To check for the number of different blood cell types (complete blood count)
  • To examine the appearance of platelets under a microscope (peripheral blood smear exam)
  • To check for any recent viral infection
  • Tests, such as partial thromboplastin time (PTT) and prothrombin time (PT), to check for blood clotting time
• Bone marrow test to check its health; this may include bone marrow aspiration and/or biopsy
• Abdominal ultrasound imaging to examine for any spleen abnormalities

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Immune Thrombocytopenia?

The following are some complications associated with Immune Thrombocytopenia:

• Rarely, bleeding inside the brain, which causes headache and other neurological symptoms (hemorrhagic stroke)
• Unusual bleeding in the digestive tract
• Severe anemia, neurological abnormalities, and kidney failure
• Recurrence of the condition

How is Immune Thrombocytopenia Treated?

The treatment options for Immune Thrombocytopenia depend on the cause and severity of the condition. The treatment options, particularly for severe episodes, may include:

• Medications such as:
  • Corticosteroids, to slow down the damage caused to the platelets
  • Immunoglobulins, to improve the immune system
  • Medicines to increase platelet production, such as rituximab
• Platelet transfusions: This may be performed in individuals, who are at a high risk for extensive and continuous bleeding
• Splenectomy: Surgical removal of spleen when medications are not effective, particularly in individuals who have Immune Thrombocytopenia
• Discontinuing medications that may cause bleeding episodes
• Treating underlying infections, if any
• Mild episodes may not require any treatment, especially in children with acute forms; however, regular follow-up is recommended

How can Immune Thrombocytopenia be Prevented?

The following preventative measures can be adopted to reduce the incidence of Immune Thrombocytopenia and associated signs and symptoms:

• Discontinuing medicines causing decreased platelet count
• Avoiding indiscriminate use of aspirin and other painkillers
• Getting vaccinated against viral infections 
• Avoiding injuries and bruises that can start bleeding episodes
• Avoiding sports and other physical activities that may potentially cause injuries and bruises
• Taking precautionary vaccination following splenectomy, to avoid infections

What is the Prognosis of Immune Thrombocytopenia? (Outcomes/Resolutions)

The prognosis of Immune Thrombocytopenia usually depends on the cause, type, and severity of the condition.

• The prognosis, in case of mild Immune Thrombocytopenia is usually excellent
• In children with acute forms, the condition resolves spontaneously within a maximum period of 6 months (usually within a few weeks to months)
• In case of chronic Immune Thrombocytopenia, the condition can even last several years to decades
• In individuals with severe bleeding episodes (such as bleeding in the brain), the prognosis can be guarded

Additional and Relevant Useful Information for Immune Thrombocytopenia:

The following DoveMed website link is a useful resource for additional information:

http://www.dovemed.com/diseases-conditions/blood-disorders/