Do you also bleed profusely even from a small wound? Let's look at ITP (Immune Thrombocytopenia)!

Do you sometimes wonder why even a small bruise turns into a big bruise, or why a small cut won't stop bleeding? Or do you experience things like nosebleeds for no reason, or bleeding gums when brushing your teeth? If these things happen to you often, perhaps it is very important for you to be aware of the condition we are talking about today called ITP (Immune Thrombocytopenia). Don't worry, let's talk about this simply.

What is ITP (Immune Thrombocytopenia)?

Simply put, ITP (Immune Thrombocytopenia) is a condition in which your blood has a low number of small cells called platelets . These platelets are what help stop bleeding when we get an injury somewhere in our body. They form a clot and stop the bleeding . So, when the number of these platelets decreases, your blood does not clot as easily. That is why even a small injury can cause excessive bleeding, or you can simply bruise your body.

This is called ITP, and the word `Immune` means something related to the immune system. `Thrombocytopenia` means low platelets. So, what happens in this is that your own immune system , the soldiers that protect us from diseases, mistakenly thinks that your own platelet cells are an outside enemy and attacks and destroys them. It's like attacking someone in your own house, thinking that they are a thief.

Sometimes ITP can be treated with or without medication and gets better over time. But for some people, it can be a chronic condition. This means that while symptoms can be controlled, it is difficult to completely cure. In such people, treatment may be required for the rest of their lives.

What are other names for ITP?

When you go to a doctor, they may use other names besides ITP. So it's a good idea to remember these names as well:

• ``Autoimmune Thrombocytopenic Purpura''
• ``Immune Thrombocytopenic Purpura''
• `Idiopathic Thrombocytopenic Purpura` (This name was used a lot in the past, `Idiopathic` means that the exact cause is unknown)
• `Werlhof disease`
• `Autoimmune Thrombocytopenia`

No matter what name you give it, it often refers to the same medical condition.

How common is ITP?

Actually, ITP is a rather rare condition. It is not a disease that affects everyone. Statistically, in a country like America, about four out of every hundred thousand (4/100,000) children and three out of every hundred thousand (3/100,000) adults are newly diagnosed with this condition each year. This condition is also seen in Sri Lanka, but it is a bit difficult to find exact statistics about it. But so, if someone has this condition, it can be a big problem for them, right?

Are there types of ITP?

Yes, ITP can be divided into two main types:

1. Primary ITP: As mentioned earlier, this is when your own immune system attacks your platelets for no apparent reason. About 80 percent (80%) of ITP patients fall into this category. This is an ``Autoimmune disorder'', meaning it is caused by a malfunction of the immune system.

2. Secondary ITP: This occurs when the platelet count decreases as a side effect of another underlying medical condition, infection, or medication. For example:

• Some long-term infections, such as HIV, Hepatitis C, or H. pylori (a bacteria that causes stomach ulcers)
• Blood cancers
• Other `(autoimmune disorders)` (e.g. lupus - SLE)
• It could also be due to some medications.

Doctors also classify ITP based on how long it has been present:

• Acute ITP: This usually gets better within three months. It is most common in children.
• Persistent ITP: This can last from three months to twelve months (one year).
• Chronic ITP: This lasts for more than a year. It is most common in adults.

What are the symptoms of ITP?

Some people may have ITP without any symptoms. However, if symptoms do occur, they may come on gradually or suddenly. The main symptoms are:

• Petechiae: This is when you see small red or purple spots on your skin, especially on the lower legs. They look like a rash. These don't go away on their own.
• Purpura: The petechiae mentioned earlier merge to form larger red, purple, or brown spots. These are smaller than a bruise, but larger than those spots. This is caused by a small amount of blood leaking from small blood vessels under the skin.
• Bruises easily: Even a slight bump anywhere can cause a large bruise or bruise. Sometimes, bruises can appear for no apparent reason.
• Bleeding gums: Your gums may bleed when you brush your teeth or just when you are still. Your gums may also appear swollen.
• Blood in stool: If your stool looks very dark, like tar, it could be internal bleeding.
• Blood in urine: If the water in the toilet bowl looks pink or red when you urinate, it could be because there is blood in the urine.
• Heavy menstrual periods in women: If your monthly period lasts more than seven days, or if you bleed a lot more than normal (`Menorrhagia`), that could also be a sign of ITP.
• Frequent nosebleeds.
• Large bruise (Hematoma): Sometimes a large, swollen bruise (`Hematoma`) can form when a lot of blood collects in one place.
• Feeling very tired (Fatigue).

Important: If you have one or more of these symptoms, it is very important to see a doctor immediately for advice.

What are the causes of ITP?

As we've discussed before, ITP occurs when your immune system mistakenly makes antibodies against your own platelets, which then tell other immune cells to destroy them. When a blood vessel in your body is damaged, platelets are the ones who come to the site, stick together, form a blood clot, and stop the bleeding. This is called ``primary hemostasis''.

However, even experts are still not clear on exactly why this immune system starts attacking its own platelets.

However, some research has found:

• For those infected with `(HIV)` (Human Immunodeficiency Virus)
• For people with a bacterial infection called `(H. pylori)` (Helicobacter pylori) (this is often linked to stomach ulcers and gastritis)
• For people with a liver disease called `(Hepatitis C)`

There is an increased risk of developing ITP. These can lead to secondary ITP.

How is ITP diagnosed?

Before a doctor can determine if you have ITP, they will first do a thorough physical examination to check for signs of bleeding, bruising, and spots like petechiae and purpura. They will then ask about your past medical history, medications you are taking, and whether anyone in your family has had bleeding problems.

Because the symptoms of ITP can be similar to those of other blood clotting disorders or even more serious diseases like blood cancer, the doctor will rule out all other causes (a diagnosis of exclusion) before making the definitive diagnosis of ITP.

What tests are used to diagnose ITP?

Doctors usually do these tests:

• Complete Blood Count (CBC): This checks the number of different types of cells in your blood, including red cells, white cells, and especially platelets . In ITP, these platelets may be very low.
• Peripheral Blood Smear: In this test, a drop of blood is taken, spread on a glass slide, and examined under a microscope to see if the shape and size of the platelets are normal, or if there are any other abnormalities.

If your doctor thinks you are at risk for HIV, Hepatitis C, or H. pylori, they may also do tests for those infections. Sometimes a bone marrow biopsy may be done, but this is not done for everyone.

What are the treatments for ITP?

Most of the time, when children develop ITP, the symptoms are not too severe and they get better without any treatment. However, adults often need treatment, especially if their platelet count is very low or if there is a risk of bleeding.

If you need treatment, your doctor may prescribe medications to increase your platelet count or to stop your immune system from attacking your platelets. The main types of medications used are:

• Corticosteroids: (e.g. Prednisolone). These work by temporarily stopping the production of antibodies that destroy platelets. These are a first-line treatment.
• Immunoglobulin (IVIg): This is a medication given intravenously. It also changes the way the immune system works and reduces the destruction of platelets.
• Thrombopoietin receptor agonists (TPO-RAs): These medications help the body make more platelets.
• Immunosuppressants: (e.g. Rituximab, Mycophenolate). These reduce the activity of the immune system and stop the destruction of platelets.

In addition to these medications, the doctor may also recommend other measures:

• Treating an underlying infection: In cases of secondary ITP, the platelet count may return to normal once the infection that caused it is treated.
• Stopping certain medications: If you are taking any blood thinners, such as aspirin, which increase the risk of bleeding, your doctor may ask you to stop taking them.
• Platelet transfusion: If your bleeding is very severe and your platelet count is very low, you may be given platelets from someone else's donation. However, this is a temporary solution.
• Splenectomy: The spleen is a part of the body that removes old and damaged blood cells, as well as platelets that have been marked with antibodies. In some people, if other treatments fail to control the disease, the spleen is removed surgically. This can largely control the condition of ITP. However, removing the spleen can increase your risk of developing certain infections.

Side effects of treatment

Like any medication or treatment, ITP treatments can cause some side effects . For example, corticosteroids can cause weight gain, facial swelling, insomnia, and mood swings. Your doctor will explain what these are and what they look like to you. This way, you can be aware of them in advance and talk about them if you have any concerns.

What is the outlook for ITP?

The outlook/prognosis varies from person to person, depending on the type of ITP.

• If children develop acute ITP, most of them will recover completely without treatment within a few weeks or months.
• If adults have chronic ITP, it can be a lifelong condition. But, there's no need to worry. Most people can manage their symptoms well with medication and other treatments and live a normal life. Although doctors can't completely cure ITP, many people with chronic ITP live well with the condition for decades.

How do I take care of myself?

If you have ITP, you may need to take medication for the rest of your life to make sure your body makes enough platelets. You'll also need to avoid activities and habits that put you at risk of injury and bleeding. Think about it, even a small fall can be a big problem, right? So be aware of these things:

• Stay away from contact sports that involve hitting, falling, and hard body contact , such as football, rugby, boxing, karate, basketball, and ice hockey, as much as possible.
• If your child has ITP, make sure they wear protective gear like a helmet, knee pads, and elbow pads when they engage in any activity, such as cycling, skateboarding, or roller skating.
• When traveling in a car or van, always wear a seat belt , and don't forget to properly fasten your child's seat belt or place them in a car seat.
• If you are taking any over-the-counter medications or herbal supplements, talk to your doctor about them and get their approval . Some painkillers, such as aspirin and ibuprofen, as well as some herbal remedies, can increase the risk of bleeding.

When should I see the doctor?

If you are diagnosed with ITP and are receiving treatment, your doctor will check you regularly. However, in the meantime:

• If you see new bruises ,
• If you have small red dots (`petechiae`) on your skin,
• If you feel like you're bleeding more easily than usual,

This means that your condition may be getting worse, or your platelet count may be low. In that case, see your doctor as soon as possible. He or she can recheck your platelet levels and adjust your treatment if necessary.

When should I go to the Emergency Department (ETU) ?

This is very rare, but sometimes ITP can cause your platelet count to drop too low and you start to bleed uncontrollably. For example, if you have a nosebleed that won't stop, a bleeding mouth, heavy menstrual bleeding, or a wound that you can't stop even with pressure, it's a medical emergency. In such cases, you should go to the nearest hospital emergency room immediately. Also, if you hit your head or have signs of bleeding inside the brain, such as a severe headache, vomiting, or changes in vision, go to a hospital right away.

What questions should I ask my doctor?

When you find out you have ITP, you may have many questions. Don't be afraid or embarrassed to ask your doctor about all of them. Here are some questions you can ask:

• What type of ITP do I have? (Acute, chronic, primary, secondary?)
• What treatment would you recommend for me? Why?
• How long will it take for those treatments to produce a cure/result?
• Will I have to take this treatment every day?
• If the first treatment is not successful, what next?
• What are the side effects of these treatments? What should I do if they occur?
• What changes should I make to my diet and lifestyle?
• What exercises are good for me to do? What exercises are not good for me to do?

What happens if I get pregnant while I have ITP?

If you are pregnant or planning to become pregnant, learning that you have ITP can be very scary. But you can take comfort in knowing this: ITP usually does not directly affect your unborn baby.

The baby's platelet count may be slightly low when they are born, but this is usually temporary and will increase within a few days. Doctors will check the baby's platelet levels.

If you have mild ITP during pregnancy, and your symptoms are not severe, you may not need any treatment. However, if your platelet count is very low or you are at risk of bleeding, you may need treatment. In such cases, your obstetrician and hematologist will work together to choose the safest treatment for you and your baby . They will also take special care during delivery.

Finally, things to remember (Take-Home Message)

Okay, so now you have a good understanding of what we've been talking about, ITP (Immune Thrombocytopenia). Here are some important things to remember:

• ITP is a condition in which your immune system destroys your own platelets, causing decreased blood clotting.
• Symptoms may include easy bruising, red spots on the skin, and frequent bleeding.
• When this happens to children, it often gets better with time. Adults may need long-term treatment.
• Although ITP cannot be completely cured, with good treatment, symptoms can be controlled and a quality of life can be achieved.
• If you have these symptoms, don't be afraid to see a doctor. He or she will give you the advice and treatment you need.
• Protect yourself from injuries, follow medical advice, and take your medications as prescribed.

ITP can be a scary condition, especially when you're just bleeding. But you're not alone. There are doctors who can help you and take care of you. So, face this situation with courage. If you have any concerns, be sure to talk to your doctor.

` ITP, Immune Thrombocytopenia, platelets, blood clotting, bleeding, immune system, bruising, petechiae, purpura