Everything You Need to Know About ITP
Immune thrombocytopenia (ITP blood disorder), formally known as immune thrombocytopenic purpura, is a blood disorder that can affect both children and adults. The term thrombocytopenia is used to refer to the decreased number of platelets and purpura refers to the bruising or discoloring of the skin. Platelets are colorless cell fragments that exists in the blood to help stop bleeding and form clots. The normal platelet count for a human being is between 150,000 to 450,000. In ITP, the count is significantly below that at less than 100,000, which increases the risk of bleeding. As a result, ITP leads to internal bleeding, reddish dots that resemble a rash, skin bruising easily, and/or bleeding gums.
The prevalence of ITP in high income countries is approximately 3 to 10 per 100,000 children per year below the age of 16. ITP can present as either acute or chronic. Acute ITP is the most common form of ITP and usually does not require treatment. It most commonly occurs in children between the ages of 2 to 6 years old. The symptoms may occur due to a viral infection (e.g., chicken pox) and can disappear in a few weeks, or if not, less than six months. Chronic ITP is less common and affects people of every age. However, it is more common in adults and sometimes adolescents. This form of ITP can go on for a minimum of six months, several years, and even a lifetime, thus constant follow up with a haematologist (blood specialist) is required.
Causes of ITP
ITP mostly occurs a result of low/decreased platelet count in the blood. This happens when the immune system makes antibodies that attack the body’s platelets. This immune system reaction can be caused by a few factors:
- Infections such as AIDS, hepatitis C, and chicken pox (most common factor)
- Immune disorders, such as lupus or rheumatoid arthritis
- Leukemia's or low-grade lymphomas
- Sometimes the cause is unknown
In some rare cases, a type of white blood cell (T-cells) attack the platelets leading to a decreased count in the blood.
Symptoms of ITP
The symptoms of ITP present differently in each person. However, most of the time it resembles that of other medical conditions. Therefore, you need to consult a doctor if you experience any of the following symptoms. The common symptoms of ITP are:
- Bruises (without injury) or purplish coloring around elbows or knees caused by movement
- Tiny red dots under the skin (small bleeds)
- Heavy menstrual periods
- Blood in the stool, urine, or vomit
- Bleeding gums or mouth
- Bleeding in the head which can be life threatening
ITP is mostly diagnosed through blood tests that identify whether there is a low platelet count. However, a physician might first try to rule our other possible causes of bleeding and the low platelet count. In some rare cases, a bone marrow exam might be needed.
Risk Factors for ITP
ITP seems to affect woman more than men, especially younger woman. People who also have these immune disorders can be at risk:
- Rheumatoid arthritis
- Systemic lupus
- Lymphoproliferative disorder
- Drug-induced thrombocytopenia
- Alloimmune thrombocytopenia
- Congenital/hereditary non-immune thrombocytopenia
- Antiphospholipid syndrome
Treatment for ITP
Acute ITP can be left untreated and will, in most cases, resolve on its own, especially in children. What would normally happen in these cases might be regular monitoring and platelet checks. However, for adults with ITP, treatment might be required as ITP can become severe or chronic (long term) in adults.
These forms of treatment listed below can be quite effective if tailored specifically for the individual with ITP. However, specific treatment is usually determined based on age, health status, extent of disease, tolerance to medications, procedures, and medical history.
There are two common forms of treatment for ITP:
- Intravenous gamma globulin (IVGG) treatment
These can be used to reduce the rate of platelet destruction by preventing bleeding. The effects of the steroids can be seen within two to three weeks when it is used effectively.
Intravenous Gamma Globulin (IVGG)
This is a treatment that becomes effective within 24 to 48 hours and thus acts faster than steroids. It is a protein which consists of antibodies that effectively slows down and prevents the destruction of platelets in the blood.
It should be noted, there are several side effects that can follow the above treatment options, especially use of steroids. The side effects that can present with use of steroids are:
- Weight gain
- High blood pressure
Apart from the ones listed above, there are other treatment options for ITP. These are:
- Splenectomy: The spleen is the part of the body that is most active in mediating the antibodies that destroys blood platelets. Removal of the spleen is considered in cases of chronic ITP to reduce rate of platelet destruction when other forms of treatment are not effective.
- RH immune globin: A temporary medication that stops the spleen from destroying platelets. However, the person must be Rh positive (and have a spleen) for this to be effective.
- Rituximab (Rituxan): Medication that slows down antiplatelet antibody production.
- Platelet transfusion: Getting platelets from a donor.
- Romiplostim (N-Plate) and eltrombopag (Promacta): This medication stimulates bone marrow to produce platelets. It is only used in cases where other types of treatment have failed.
ITP Lifestyle Changes
Some people might not want to take the above treatment options for personal reasons. In these cases, there are several lifestyle changes and natural treatments that can be used to reduce the destruction or stimulate production of platelets or preventative measures to keep someone with ITP safe from further harm. These are:
- Using protective gear when doing certain activities and avoiding activities that can cause bleeding in the brain due to frequent impacts to the head, such as martials arts, boxing, and football (rugby).
- Being careful of getting any infections and treating possible infections as early as possible.
- Using over-the-counter medication, such as aspirin or ibuprofen with caution. Ask your doctor first before taking these.
Natural Remedies for ITP
To help in reducing the effect of ITP, it is encouraged that people with ITP eat more foods that increase platelet counts. These are foods that contain:
- Vitamin B12: beef liver, clams, eggs, and dairy products
- Vitamin C: oranges/juice, pineapples, mangoes, broccoli, cauliflower, green/red bell peppers, and tomatoes
- Folates: peanuts, oranges or orange juice, black eyed peas, and kidney beans
- Iron: some green vegetables, mussels, beef, pumpkin seeds, and lentils/dahl
If possible, people with ITP blood disorder should avoid foods that decrease platelet counts. These are:
- Tonic water (specifically quinine a compound found in tonic water)
- Cranberry juice
- Cow’s milk
Alternative Treatments and Supplements for ITP
Papaya leaves and pegaga juice have been found to increase platelet count based on research done at the Asian Institute of Science and Technology in Malaysia in 2013.
Colostrum in found in cow’s milk and is the first substance a baby calf receives from his mother. In a 2017 study, this was found to contain proteins involved in activation of platelets and proper immune system responses.
People who specialize in prescribing ayurvedic medication often recommend herbal therapies for ITP blood disorder. An herbal mixture called Amrit Kalash (MA4, MA5) has been found to modulate the immune system responses and has strong antioxidant properties which can improve platelet production and difficulties associated with ITP.
It should be noted however that most of these remedies are not approved by the FDA for use as treatment for ITP.
Can ITP Be Prevented?
ITP blood disorder cannot be prevented. However, you can reduce risk of further complications from ITP by:
- Treating or seeking treatment for infections immediately or as soon as possible.
- Asking your doctor for advice on what medications you can and cannot take (as listed above).
- Wearing protective gear and protecting yourself from bleeding and bruising or head injuries.
- PubMed.gov (Effect of Maharishi AK-4 on H2O2-induced oxidative stress in isolated rat hearts)
- PubMed.gov (Does Carica papaya leaf-extract increase the platelet count? An experimental study in a murine model)
- PubMed.gov (Antioxidant and protective effects of Amrit Nectar tablets on adriamycin- and cisplatin-induced toxicities)
- PubMed.gov (Public safety and dietary supplementation)
- Healthline (How to Naturally Increase Your Platelet Count)
- Mayo Clinic [Immune thrombocytopenia (ITP)]
- Platelet Disorder Support Association (Herbal Therapies)