Fig. 1: Phenotypic and dysmorphic features of patient 1 (A and B),...
Idiopathic Thrombocytopenic Purpura (ITP)
ITP, or immune thrombocytopenia, is a blood clotting disorder caused by a low number of platelets. It can be either acute or chronic but is rarely life threatening. Most cases are treatable with medication.
ITP is an immune disorder in which blood doesn't clot quickly because the body lacks enough platelets. As a result, ITP can lead to excessive bruising and bleeding internally, as well as on and under the skin.
ITP used to be called idiopathic thrombocytopenic purpura, but it's now known as immune thrombocytopenia.
The condition is no longer idiopathic (which means there's no known cause) because researchers now know the condition is autoimmune. "Purpura" was dropped from the name because around one-third of those who receive a diagnosis have no bleeding.
Because of their low platelet count, people with ITP often have many purple bruises called purpura on their skin or inside their mouth. These bruises may also appear as pinpoint-sized red or purple dots, kind of like a rash, on the skin, that are called petechiae. On darker skin tones, they may appear dark brown or black.
About 40% of all cases affect children under 10 years old, though it seems to develop most frequently in kids between ages 2 and 4 years. This is especially true after they've been sick with another viral illness like chickenpox, mumps, and measles.
The two main types of ITP:
Platelets are created in the bone marrow. They help blood cells stick to each other and proteins to seal and heal wounds and cuts. But when platelet levels are low, as they are with ITP, it takes longer for wounds to stop bleeding and heal.
Platelet levels are low with ITP because with this immune disorder, your immune system antibodies attack and destroy platelets.
ITP is not contagious and cannot be passed from one person to another. But it can be classified as primary, meaning it occurs on its own, or it can be secondary, which means that another condition triggers it.
Possible triggers for secondary ITP include:
ITP doesn't always cause noticeable symptoms. Someone with ITP can also be asymptomatic for long periods of time and not have any symptoms until they have an episode.
If there are symptoms, the most common ones include:
To receive an ITP diagnosis, your doctor will start by performing a complete physical exam. They'll ask you about your medical history and the medications you're taking.
Your doctor will also order blood tests that could measure:
Your doctor will also request a blood smear. During this procedure, a healthcare professional will take a blood sample. It's placed on a glass slide and viewed under a microscope to verify the number and appearance of platelets seen in the complete blood count.
If you have a low platelet count, your doctor may also order abone marrow test. If your bone marrow is abnormal, another disease rather than ITP is likely causing your low platelet count.
But if you have ITP, your bone marrow will be normal. This is because your platelets are destroyed in the bloodstream and spleen after they leave the bone marrow, not in your bone marrow itself.
Your doctor will choose your treatment based on the following:
In some cases, treatment isn't needed. For example, children who develop the acute form of ITP usually recover within 6 months or less without treatment.
Adults with less severe cases of ITP may also not require treatment. However, your doctor will still want to monitor your platelet and red blood cell counts to ensure that you don't need treatment in the future.
Platelet counts that drop too low put you at risk of spontaneous bleeding in the brain or other organs, while a low red blood cell count can be a sign of internal bleeding.
Medications
If you or your child requires treatment, your doctor will likely prescribe medications as the first course of treatment. The most common medications used to treat ITP include:
Corticosteroids
Your doctor may prescribe a corticosteroid like prednisone (Rayos), which can increase your platelet count by decreasing the activity of your immune system.
Intravenous immunoglobulin (IVIg)
If your bleeding has reached a critical level or you're going to have surgery and need to increase your platelet count quickly, you may be given intravenous immunoglobulin (IVIg).
Anti-D immunoglobulin
This is for people who have Rh-positive blood. Like IVIg therapy, it can quickly increase the platelet count, and it may work even faster than IVIg. However, it can have serious side effects, so individuals should be careful with this treatment.
Rituximab (Rituxan)
This antibody therapy targets the immune cells responsible for producing the proteins that attack platelets. When this medication binds to those immune cells, known as B cells, they're destroyed.
This means fewer cells are available to make the proteins that attack platelets.
Thrombopoietin receptor agonists
Thrombopoietin receptor agonists, including romiplostim (Nplate) and eltrombopag (Promacta), help prevent bruising and bleeding by stimulating the bone marrow to produce more platelets.
The Food and Drug Administration (FDA) has approved both of these medications for the treatment of low platelet counts due to chronic ITP.
General immunosuppressants
General immunosuppressants are generally only prescribed if the other drugs listed above do not improve your symptoms and if you have a severe case of ITP.
Immunosuppressants inhibit the overall activity of the immune system, not just the specific components related to ITP. As a result, they can have significant side effects.
These medications are generally avoided today.
Antibiotics
Helicobacter pylori, which is the bacteria that causes most peptic ulcers, has been associated with ITP in some people. So if other medications do not work, some doctors may consider prescribing antibiotic therapy to eliminate H. Pylori because that has been shown to help increase platelet counts in some people.
But more research is still needed on the effectiveness of this strategy, so it's not considered standard treatment.
Surgery
If you have severe ITP and medication does not improve your symptoms or platelet count, your doctor may advise having surgery to remove your spleen. This is called a splenectomy.
Splenectomy isn't usually performed in children because of the high rate of spontaneous remission or unexpected improvement. Having a splenectomy also increases the risk of certain bacterial infections in the future.
Emergency treatment
Severe or widespread ITP requires emergency treatment. This usually includes transfusions of concentrated platelets and intravenous administration of a corticosteroid like methylprednisolone (Medrol), IVIg, or anti-D treatments.
Lifestyle changes
Your doctor may also advise you to make some lifestyle changes, including:
Treatment for pregnant people with ITP depends on the platelet count. If you have a mild case of ITP, you probably won't need any treatment other than careful monitoring and regular blood tests.
But if you have an extremely low platelet count and it's late in the pregnancy, you're more likely to experience serious, heavy bleeding during and after delivery. In these cases, your doctor will work with you to determine a treatment plan that will help maintain a safe platelet count without adversely affecting your baby.
If you experience ITP along with other serious conditions of pregnancy, such as preeclampsia, you'll need treatment as well.
Although most babies born to mothers with ITP aren't affected by the disorder, some are born with or develop a low platelet count soon after birth. Treatment may be necessary for babies with very low platelet counts.
The most dangerous complication of ITP is bleeding, especially bleeding into the brain, which can be fatal. But serious bleeding is rare.
In fact, some of the treatments for ITP can have more risks than the disease itself. For example, the long-term use of corticosteroids can cause serious side effects, including:
Surgery to remove the spleen increases your risk of bacterial infections and the risk of becoming seriously ill if you develop an infection. If you have a splenectomy, it's important to watch for any symptoms of infection and report them to your doctor promptly.
For most people with ITP, the condition isn't serious or life threatening.
For example, acute ITP in children often resolves within 6 months or less without treatment. Chronic ITP, though, can last for many years. Still, people can live for many decades with the disease, even those with severe cases.
Many people with ITP are able to manage their condition safely without any long-term complications or a decreased life span.
What Is Mandy Moore's Blood Disorder, Thrombocytopenic Purpura?
Mandy Moore is known for her incredible acting and singing, and she recently completed her tenure with This Is Us. Fans know Moore best for her role as Rebecca Pearson, the incredible mother of the Pearson kids. Not only did Moore play a mother, but she is one and currently pregnant. Unfortunately, she can't have an epidural during childbirth due to her rare blood disorder. So, what is Mandy Moore's disorder?
How many kids does Mandy Moore have? She's currently pregnant Mandy MooreAxelle/Bauer-Griffin/FilmMagicMandy Moore played a fantastic mom on This Is Us, as the show told the story of Rebecca Pearson's early days to death. As for real life, she told Parents that she always hoped for the "opportunity" to become a mom. She currently has one child, August "Gus" Harrison, born in February 2021, and she's pregnant with her second.
"Not to sound cheesy, but all the clichés are true. Life is Technicolor now," Moore told Parents. "It just makes sense in a way that it didn't before. I had no idea that this degree of love existed in the world."
While she adores parenthood, it's not always easy. "Once that initial wave of new-parent euphoria sort of wore off, when the chaos of those early weeks started to wane, and the extra support we had in the beginning started tapering off, the reality of being Mom was suddenly front and center," she added. "It was scary. Like, 'Oh, wow. Now the onus is on me. Do I know what I'm doing?'"
What is Mandy Moore's blood disorder, thrombocytopenic purpura?Mandy Moore's blood disorder will prevent her from getting an epidural when she gives birth to her second child, Today Parents reports. Moore has an autoimmune disorder known as immune thrombocytopenic purpura (ITP).
So, what is ITP? According to the Mayo Clinic, the disorder can cause excessive bruising or bleeding due to unusually low levels of platelets. The platelets help blood to clot. The condition can also cause purple bruises as well as small, rash-like dots that are reddish-purple in color. Other symptoms include bleeding gums or nose, blood in the urine or stool, and unusually heavy periods in those with uteruses.
As for how ITP develops, the Mayo Clinic explains the disorder occurs when your immune system attacks and destroys platelets. This can be triggered by an infection like HIV, hepatitis, or H. Pylori, and in kids, ITP can occur following a viral illness.
How her disorder affects her pregnancy Mandy Moore and Taylor GoldsmithAxelle/Bauer-Griffin/FilmMagicSo, what does Mandy Moore's disorder have to do with her pregnancy? The Mayo Clinic notes ITP is associated with a higher risk of heavy bleeding during delivery. Doctors may suggest treatment to stabilize the platelet count. Moore told Today Parents that giving birth without an epidural the first time was "awful," but she's ready to do what she needs to do.
"But I can do it one more time," she said. "I can climb that mountain again. I wish medication was an option — just the idea of it being on the table is so nice. But we'll just push forth like we did last time."
The Mayo Clinic notes most adults with ITP eventually need treatment, which could mean medications to boost platelets or surgery on the spleen. It's unclear how Moore manages her ITP, but it seems she has options if necessary.
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Immune Thrombocytopenic Purpura Symptoms
Immune thrombocytopenia (ITP) affects how the blood clots and may result in various symptoms, such as unexplained bruises, frequent bleeding from the gums and nose, and fatigue.
Immune thrombocytopenia (ITP), previously known as idiopathic thrombocytopenia, is a rare blood disorder characterized by low platelet counts, which affect the blood's ability to clot.
For many people, ITP doesn't cause symptoms. When they do appear, platelet levels are often very low, which leads to excessive bleeding. This can result in symptoms like:
A normal platelet count is needed to control bleeding throughout the body. Most of the time, the bleeding is contained underneath the skin and appears as a bruise, so you might think ITP-related symptoms as something else.
Other more serious symptoms of ITP can be related to more significant internal or external bleeding.
Some signs of ITP may seem unusual. We'll walk through the common symptoms of ITP and cover which may indicate a need for urgent medical attention.
One of the most common symptoms of ITP is a skin condition called petechiae. These are small reddish bumps on your skin caused by bleeding from underneath.
Petechiae can look like a rash at first, but the bumps are slightly raised, scattered, and the size of pinpoints. They can also have a purplish tinge.
If you notice petechiae or any unusual rash, a healthcare professional can provide diagnosis and treatment.
Bruises are the result of injuries that cause capillaries to break just underneath the surface of the skin. Blood comes out of these broken capillaries, forming a pool. This creates black-and-blue bruises.
Bruises naturally fade over time as the blood reabsorbs into the body. They're not usually cause for concern.
There can be many reasons for bruising, including:
However, you might notice you're bruising a lot more easily, especially on your arms and legs. You might even wake up with bruises, or get new bruises without having been hurt.
Sometimes frequent bruising is a symptom of ITP. Low levels of blood platelets can make it more difficult for your blood to clot, causing the skin to bruise even after a minimal injury.
Bruises from ITP are called purpura. They're usually purple. They can also appear inside your mouth.
When we think of the word "skin," the gums may not come to mind at first. But ITP can affect this delicate skin too.
Gum bleeding from ITP may occur during dental work, like routine teeth cleaning or other dental procedures.
In severe cases, your gums could bleed from brushing and flossing.
You may attribute this bleeding to gingivitis (gum inflammation) instead of an ITP symptom. At your cleanings, your dentist may also notice bruises inside your mouth.
Low platelet counts from ITP can affect your menstrual cycle, making periods heavier than usual.
While heavy periods might seem more like a nuisance than anything else, they can also lead to complications, such as anemia.
An occasional heavy menstrual cycle might not be a cause for concern. But if you begin experiencing a heavy period every month, talk with a healthcare professional.
The low platelet count associated with ITP can also cause bleeding in your urine or stools.
Blood in the urine typically occurs as a sign of infection. However, bladder infections often accompany other symptoms, such as:
If you don't have any other symptoms of a bladder infection, blood in your urine could be an early indicator of ITP.
Blood in the stool is never normal. If you see blood in your urine or stools, you may want to follow up with a healthcare professional.
Red blood cells transport oxygen throughout your body, which helps your tissues and organs function properly. When you bleed, your body takes time to replace the blood.
Moderate bleeding can lead to anemia. You might feel overly fatigued as a result.
Signs of excessive fatigue include:
If you have any signs or symptoms of anemia, a healthcare professional can conduct testing to determine a diagnosis.
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