Idiopathic thrombocytopenic purpura: Causes, Symptoms, Treatment and Cost

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune condition characterized by reduced platelet levels (thrombocytopenia) in the blood.

• Immune thrombocytopenic purpura (ITP): This is the most common kind of idiopathic thrombocytopenic purpura. It happens when the body's immune system erroneously destroys platelets, which are essential for clotting. Without sufficient platelets, bleeding may occur under the skin and in other organs, leading to bruises, petechiae (small red patches), and other bleeding issues.
• Non-immune thrombocytopenic purpura (NITP): This type of idiopathic thrombocytopenic purpura is caused by a problem with platelet production rather than an autoimmune response, leading to decreased platelet counts in the blood. It is usually seen in patients with advanced age or underlying medical conditions such as chronic kidney disease or liver disease.
• Drug-induced thrombocytopenic purpura: This type of ITP is caused by certain medications that cause the body to produce antibodies against its own platelets, leading to decreased numbers of circulating platelets in the blood. The most common drugs associated with drug-induced ITP are quinine, heparin, and sulfonamides (a group of antibiotics).

Because the precise causes for ITP are unclear, it is believed that both hereditary and environmental factors play a role. Among the possible causes of Idiopathic Thrombocytopenic Purpura are:

• Genetic Predisposition: People with a family history of ITP or other autoimmune disorders may be more likely to develop ITP.
• Infections: In certain circumstances, viral infections such as Epstein-Barr virus and HIV may cause ITP.
• Medications: Some medicines, such as antibiotics and anticonvulsants, might increase a person's chance of getting ITP.
• Pregnancy: ITP is more likely to happen to pregnant women because of the changes in hormones that happen during pregnancy.
• Autoimmune Disorders: People with other autoimmune disorders, such as lupus or rheumatoid arthritis, may be at increased risk for developing ITP.

• Easy or excessive bruising: As the number of platelets decrease, it is more difficult for the body to form clots when necessary. This may result in easy or excessive bruising and bleeding.
• Unusually heavy menstrual periods: Women with ITP may experience unusually heavy menstrual bleeding due to the lack of platelets in their bodies.
• Unexplained nosebleeds: Platelets are important for clotting and when there are not enough of them, this can lead to unexplained nosebleeds that may be difficult to stop.
• Tiny red spots on the skin: These spots, known as petechiae, are caused by small blood vessels bursting due to low platelet counts. They may look like a rash but will not itch or hurt.
• Bleeding from the gums: Low platelet counts can cause bleeding from the gums when brushing your teeth or eating certain foods.

• Avoiding excessive alcohol consumption, as it can weaken the immune system and increase the risk of developing ITP.
• Regular exercise may help improve one's immunity and promote health in general.
• Minimising stress levels and practising relaxation techniques such as yoga or meditation to keep stress levels low.
• Getting adequate sleep so that your body has sufficient time to relax and recover from everyday activity.
• Taking regular medications prescribed by your doctor for any existing health conditions that may be putting you at a higher risk for developing ITP.

• Complete Blood Count (CBC): This is the most common diagnostic test for ITP. It measures the number of platelets in the blood and can help diagnose ITP by showing a low platelet count.
• Bone Marrow Examination: During this test, a sample of bone marrow is taken from the sternum or hip bone and examined under a microscope. It can help diagnose ITP by showing an absence or decrease in megakaryocytes, which are responsible for making platelets.
• Antiplatelet Antibody Tests: These tests measure antibodies in the blood that are created against platelets, which can be a sign of ITP.
• Bone Marrow Biopsy: This is similar to a bone marrow examination, but it involves taking a larger sample of bone marrow to look for abnormalities that may indicate ITP, such as an absence or decrease in megakaryocytes.
• Platelet Function Tests: These tests measure how well platelets are functioning and can help determine if there is a problem with them, such as with ITP.
• Ultrasound: An ultrasound can be used to look for enlarged spleen, which is often associated with ITP.

• Bleeding: Even small wounds might result in significant bleeding if there are not enough platelets present in the blood.
• Anaemia: A low platelet count can cause anaemia due to the reduced ability of the body to produce red blood cells. This can lead to fatigue, paleness, and shortness of breath.
• Organ damage: Without enough platelets in the blood, serious internal bleeding can occur and cause damage to organs such as the brain, kidneys, lungs, and liver.
• Infection: People with ITP are more likely to develop infections because their bodies lack enough platelets to fight off bacteria and viruses properly.

• Ashwagandha: Ashwagandha is an ayurvedic herb that has many health benefits, including the ability to increase platelet count. Its anti-inflammatory and antioxidant properties can help reduce inflammation in the body, which in turn can help improve platelet count.
• Neem: Neem is known to be effective in treating various types of infections, including those related to ITP. Neem can also help reduce inflammation and improve circulation, which can help increase platelet count.
• Turmeric: Turmeric contains compounds that are known to have anti-inflammatory and antioxidant properties, which can help reduce inflammation and improve circulation in the body, thus helping to improve platelet count.
• Ginger: Ginger can help reduce inflammation and improve circulation throughout the body, which can help increase platelet count in ITP patients. Additionally, ginger may also be beneficial for reducing pain associated with ITP symptoms such as bruising and bleeding easily from minor cuts or scrapes.

• Foods high in vitamins, minerals, and other nutrients are important for maintaining overall health and can help the body fight off infections.
• Protein-rich foods such as lean meats, fish, eggs, beans, nuts, and seeds should be included in the diet to help maintain normal platelet counts.
• To maintain sufficient intake of vital nutrients, it is advised to eat a lot of fresh fruits and vegetables every day.
• Whole grains should also be included in the diet as they provide complex carbohydrates that can help the body stay fueled for longer periods of time. Whole grains are also high in fibre, which aids digestion and general health.
• Foods that are high in omega-3 fatty acids such as salmon, mackerel, tuna, walnuts, flaxseed oil, and chia seeds can help reduce inflammation in the body which can be beneficial for those with ITP.
• It is also important to stay hydrated by drinking plenty of water throughout the day as this can help with fatigue associated with ITP as well as maintaining healthy platelet levels.

• High-Vitamin K Foods: Vitamin K helps the clotting process, so it is best to avoid foods high in vitamin K, such as kale, spinach, broccoli, turnip greens, and Brussels sprouts.
• Alcohol: Alcohol may disrupt the body's clotting function, increasing the risk of bleeding. Alcohol should be avoided or used in moderation.
• Processed meats: Preservatives found in processed meats, including hot dogs and lunch meats, may interfere with platelet function and raise the risk of bleeding.
• Certain Fish: Fish that contain high levels of omega-3 fatty acids such as salmon and mackerel should be avoided because they can reduce clotting ability.
• Foods high in Aspirin-like substances: Foods such as papaya, banana peels, tomatoes, and eggplant contain natural salicylates (a substance similar to aspirin) which can increase your risk of bleeding if consumed in large amounts.

• Steroid Therapy: Steroid therapy is the main treatment for Idiopathic thrombocytopenic purpura (ITP). Steroids help to stop the immune system from attacking and destroying healthy platelets, which helps to increase the platelet count.
• Intravenous Immunoglobulin: Intravenous immunoglobulin (IVIG) is an intravenous infusion of antibodies taken from blood donors. It helps to decrease the body’s ability to attack and destroy platelets, thus increasing the platelet count.
• Splenectomy: Splenectomy is a surgical process that removes the enlarged spleen caused by ITP. Removing the spleen can help increase the platelet count, but it can also put patients at risk for certain infections and other problems.
• Platelet Transfusions: Platelet transfusions can be used in some cases of ITP, especially when there is a high risk of bleeding due to a very low platelet count. Platelets are given intravenously and will help increase the platelet count temporarily until other treatments take effect.

Haematologists are the go-to medical professionals when dealing with ITP. Haematologists are medical professionals who focus on the study and treatment of blood disorders like ITP.

They have expertise in diagnosing and treating conditions such as ITP, and they can recommend medications or other treatments that may help reduce platelet counts or improve platelet function.

• Corticosteroids: Inflammation may be reduced and the immune system strengthened using corticosteroids like prednisone and dexamethasone.
• Immunoglobulins: These drugs, such as intravenous immunoglobulin (IVIG) or anti-D immunoglobulin, are given to replace the missing antibodies in the body that are needed to fight infection.
• Anti-D immunoglobulin: This is a specific type of IVIG used for pregnant women with ITP to prevent foetal destruction from maternal antibodies attacking the foetus.
• Antiplatelet agents: These drugs, such as aspirin and clopidogrel, are used to prevent platelets from clumping together and forming clots that can block arteries and cause stroke or heart attack.
• Thrombopoietin receptor agonists (TPO-RA): These drugs, such as eltrombopag and romiplostim, stimulate production of platelets in order to reduce symptoms of ITP.

The duration of recovery from Idiopathic thrombocytopenic purpura (ITP) is based on the individual and the aetiology of the disorder.

In mild cases, recovery can be within a few weeks, while more severe cases may take months or even years.

No, treatment outcomes are not always lasting. Depending on the type of treatment and its effectiveness, the results can be long lasting or temporary.

Post-treatment guidelines are:

• Follow-up appointments: Depending on the procedure, patients may need to schedule regular follow-up appointments with their doctor or specialist. This is critical for tracking progress and ensuring that any potential issues are addressed as soon as possible.
• Medication: Certain procedures may require patients to take medication to manage pain, reduce inflammation and prevent infection. If this is the case, it is important that they take the correct dosage and frequency as prescribed by their doctor.
• Diet and exercise: After certain procedures, it is beneficial to follow a healthy diet and exercise regularly in order to promote healing and reduce swelling. Depending on the procedure, this could include avoiding certain foods or increasing physical activity levels slowly over time.
• Rest: Resting after treatment is essential for allowing the body to heal properly and can help reduce fatigue and pain levels. It is essential to pay attention to your body's needs and take required rests between activities.
• Avoidance of activities: Depending on the procedure, there may be certain activities that should be avoided in order to prevent further injury or complications from occurring. For example, following knee surgery it may be advised not to participate in high-impact activities such as running or jumping until fully recovered.

Generally speaking, ITP treatments in India can range from a few thousand rupees to several lakhs, depending on the exact treatment being done.

For example, a course of intravenous immunoglobulin therapy (IVIG) may cost around Rs. 50,000 or more and a splenectomy may cost upwards of Rs. 2 lakhs or more.

Additionally, medications for ITP may cost between Rs. 500 to several thousand rupees depending on the type and dosage being prescribed.

• Risk of infection: ITP treatments can cause a decrease in the number of white blood cells, which makes it more difficult for the body to fight off infections.
• Bleeding and bruising: ITP treatments can also reduce the number of platelets in the body. This can lead to bleeding and bruising more easily than normal.
• Hair loss: Some types of ITP treatments, such as steroids, can cause hair loss or thinning hair.
• Liver damage: Long-term use of some medications used to treat ITP can cause liver damage or even failure.

If you are experiencing any symptoms associated with idiopathic thrombocytopenic purpura, you should see a doctor as they can lead to complications such as 'bleeding, infection, anaemia, and organ damage' for which the treatment duration can range from a few months to several years, depending on the extent of the condition.