Our six year old came in from playing on a warm summer’s day. She seemed her normal, happy and carefree self, but when she jumped into my lap, I noticed dime sized bruises all over her legs, evenly spaced. It looked odd to say the least, and she couldn’t say anything had happened, so we called the clinic to discuss with the on duty nurse.
“So, you have an active 6 year old with bruises on her legs; doesn’t seem like a big deal to me,” was her response. After sharing with the nurse I didn’t think she quite understood, which she agreed – at least she couldn’t understand the worry in my voice – she asked we bring her in….
We found out she had Henoch-Schonlein purpura (HEN-awk SHURN-line PUR-pu-ruh) – a disorder that causes inflammation and bleeding in the small blood vessels in your skin, joints, intestines and kidneys. While this is not ITP, it was our introduction to the words purpura, platelets and thrombocytopenia.
September is National ITP Awareness Month
Chronic ITP and platelet function disorders are perhaps the most common bleeding disorder. It affects both sexes and all ages and races. While we don’t know for sure, there are an estimated 120,000 persons with ITP in the United States. That’s more than 10 times the number of people with Hemophilia!
The purpose of ITP awareness month is to increase the public’s awareness and understanding of ITP and to let patients and families know that there are resources and support available to help them have the best possible outcomes. Patients and families are not alone.
What is ITP?
Platelets are relatively small, irregularly shaped components of our blood. They are required to support the integrity of our blood vessel walls and for blood to clot. Without enough platelets, a person is subject to spontaneous bleeding or bruising.
Idiopathic thrombocytopenic purpura (ITP) is a disorder that can lead to easy or excessive bruising and bleeding. The bleeding results from unusually low levels of platelets — the cells that help blood clot.
Idiopathic thrombocytopenic purpura, which is also called immune thrombocytopenia, affects children and adults. Children often develop ITP after a viral infection and usually recover fully without treatment. In adults, the disorder is often long term.
If you don’t have signs of bleeding and your platelet count isn’t too low, you may not need any treatment. In rare cases, the number of platelets may be so low that dangerous internal bleeding occurs. Treatment options are available.
Idiopathic thrombocytopenic purpura (ITP) may have no signs and symptoms. When they do occur, they may include:
- Easy or excessive bruising (purpura)
- Superficial bleeding into the skin that appears as a rash of pinpoint-sized reddish-purple spots (petechiae), usually on the lower legs
- Bleeding from the gums or nose
- Blood in urine or stools
- Unusually heavy menstrual flow
In some people thrombocytopenia is caused by the immune system mistakenly attacking and destroying platelets. If the cause of this immune reaction is unknown, the condition is called idiopathic thrombocytopenic purpura. Idiopathic means “of unknown cause.”
In most children with ITP, the disorder follows a viral illness, such as the mumps or the flu. It may be that the infection triggers the immune system malfunction.
Increased breakdown of platelets
In people with ITP, antibodies produced by the immune system attach themselves to the platelets, marking the platelets for destruction. The spleen, which helps your body fight infection, recognizes the antibodies and removes the platelets from your system. The result of this case of mistaken identity is a lower number of circulating platelets than is normal.
A normal platelet count is generally between 150,000 and 450,000 platelets per microliter of circulating blood. People with ITP often have platelet counts below 20,000. Because platelets help the blood clot, as their number decreases, your risk of bleeding increases. The greatest risk is when your platelet count falls very low — below 10,000 platelets per microliter. At this point, internal bleeding may occur even without any injury.
Idiopathic thrombocytopenic purpura can occur in anyone at almost any age, but these factors increase the risk:
- Your sex. Women are two to three times more likely to develop ITP than men are.
- Recent viral infection. Many children with ITP develop the disorder after a viral illness, such as mumps, measles or a respiratory infection.
Spontaneous bleeding can also occur in mucous membranes inside the mouth or in the gastrointestinal tract. ITP is often accompanied by fatigue and sometimes depression.
A rare complication of idiopathic thrombocytopenic purpura is bleeding into the brain, or disruptive bleeding into internal organs, which can be fatal.
In pregnant women with ITP, the condition doesn’t usually affect the baby. But the baby’s platelet count should be tested soon after birth.
If you’re pregnant and your platelet count is very low, or you have bleeding, you have a greater risk of heavy bleeding during delivery. In such cases, you and your doctor may discuss treatment to maintain a stable platelet count, taking into account the effects on your baby.
When to see a doctor
Make an appointment with your doctor if you or your child develop symptoms that worry you.
Bleeding that won’t stop is a medical emergency. Seek immediate help if you or your child experiences bleeding that can’t be controlled by the usual first-aid techniques, such as applying pressure to the area.
To find a healthcare professional, use HealthLynked. It is a first of its kind medical network built as a social ecosystem with a higher purpose – improving healthcare. Go to HealthLynked.com to learn more, sign up for free, connect with your doctor, find a new doctor, and securely store and share your health information. Download our HealthLynked app available on Apple and Android devices.