diseases

IDIOPATHIC THROMBOCYTOPENIA PURPURA (ITP)


Introduction:
Idiopathic Thrombocytopenia Purpura is a bleeding disorder characterized by subcutaneous hemorrhages which occur spontaneously due to minor trauma. Normally, when there is an injury a blood clot is formed to stop the bleeding. This is done by platelets which are cells in our blood due to which blood clotting takes place.

Platelets are tiny cells that circulate in the blood and whose function is to take part in the clotting process to prevent hemorrhage - bleeding from a ruptured blood vessel.

People with Idiopathic Thrombocytopenia Purpura have low platelet count, shortened platelet survival and presence of antiplatelet antibodies. These people tend to bruise easily and bleed longer when injured. Most of the acute cases are self limiting but few may become chronic.

The disease is considered as chronic if the platelet count does not stabilize within six months. Acute ITP occurs frequently in children after viral infection. Chronic ITP is commonly seen in adults.

Cause:
The exact cause of ITP is not known. Hence it's known as 'Idiopathic'.

It is an auto immune disorder, the immune system starts attacking the platelets as if they were foreign substances. The platelets are sequestrated in spleen and survival time is diminished. Thrombocytopenia can be carried transplacentally from mother to fetus and may even cause neonatal thrombocytopenia.

Normally there are about 150,000 to 450,000 platelets per microlitre of circulating blood. The risk of bleeding increases when the platelet count falls below the normal level. Sometimes internal bleeding may occur, but this is rare.


Acute ITP can occur in young children after viral infection.

Signs and Symptoms:
. Easy bruising and subcutaneous hemorrhage (petechia) occur spontaneously after minor trauma.
. Prolonged bleeding after a minor injury.
. Excessive bruising.(Purpura)
. Bleeding from gums and nose.
. Blood in urine and stools
. Ecchymosis over the anterior surface of lower limbs and bony prominence.
. Heavy menstrual flow.
. Anemia
. Palpable spleen
. Profuse bleeding during surgery
. In secondary purpura, there is significant spleenomegaly and anemia is disproportionate to the degree of bleeding.

Complications:
. Hemorrhages in the brain may occur.
. Complications may occur from treatment with corticosteroids. Long term use of steroids may cause osteoporosis, mood swings, weight gain,
. Puffiness of face,
. Increased risk of infection
. Cataract

Pregnancy and ITP:
If the platelet count is very low during pregnancy, there is a risk of heavy bleeding after delivery. Antibodies to platelets can cross the placenta and affect the baby's platelet count. Infant's platelet count should be monitored during the first week after delivery.

Diagnosis:
Diagnosis is usually done with a medical history, symptoms, signs of bleeding or bruising, other medical problems, recent infections and medications.

Laboratory investigations done are C.B.C (Complete blood count): The platelet count is low, below 20,000.Bleeding time is prolonged.

Peripheral Blood Smear confirms the number of platelets in C.B.C.

Bone marrow examination helps to know the cause of low platelet count. Anemia or leukemia may affect the production of platelets in bone marrow.

Treatment:
. Outdoor sports are avoided to prevent bleeding complications.
. Anti Rh (D) Globulin: blocks the Fc receptors in Rh +ve individuals. This results in rise in platelet count after 48 hours of infusion.
. Splenectomy is advised for chronic ITP patients who do not respond to treatment. One of the risks of Splenectomy is an increased susceptibility to infection.
. Transfusion of platelets is done in emergency conditions when there is severe bleeding.

Homeopathic Management:
Homeopathic medicines are given after taking a detailed case history. Homeopathic medicines correct the immune system. It brings back the lost balance when it is in a diseased state. It builds the resistance power of a person making him less vulnerable to infections.

Constitutional homeopathic medicine (medicine selected after detail case taking) given to pregnant women during pregnancy protects the fetus and there are less chances of the baby developing the disease. Homeopathic medicines are safe, easy to administer and do not produce any side effects. Hence, they can be safely given to children and pregnant women.

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