PTI is a hemorrhagic disorder in which the immune system destroys the platelets that are necessary for normal blood clotting. People with the disease have very few platelets in their blood, usually below 50,000 / mm3. This condition is also called Immune Thrombocytopenic Purpura.
How it is produced and risk factors for ITP
Idiopathic thrombocytopenic purpura develops when certain cells of the immune system produce antibodies against platelets. Platelets help blood clot together by plugging small holes in damaged blood vessels. The antibodies bind to the platelets and the spleen destroys those carrying the antibodies.
In children, sometimes the disease occurs after a viral infection. In adults, it is most often a chronic (long-term) disease and can occur after a viral infection, with the use of certain drugs, during pregnancy or as part of an immune disorder.
Idiopathic thrombocytopenic purpura affects women more frequently than men, and is more common in children than in adults. In children, the disease affects both sexes equally. It occurs in about 5 cases per 100,000 live births under 15 years.
Symptoms of PTI
Abnormally abundant menstruation, bleeding in the skin that causes rashes that look like small red spots (petechial rash), prone to hematoma formation, and nose or mouth bleeding.
Diagnosis of PTI
First of all, it is a good medical record to look for personal and family history of bleeding, followed by a systematic physical examination for bleeding lesions, especially on the skin and mucous membranes.
Laboratory tests will be performed to look at how the blood coagulates and check the platelet count:
- A complete blood count or blood count shows a low number of platelets.
- Blood clotting tests are usually normal (prothrombin activity, partial thromboplastin time, and fibrinogen.
- The bleeding time is prolonged, as it is a direct reflection of the functioning of platelets in terms of how they are added.
- Antibodies associated with platelets can be detected.
- Spinal biopsy or aspirate: discarding a central or medullary origin of thrombocytopenia, in which a larger than normal number of cells called megakaryocytes, which are the precursor cells of platelets, are shown.
Treatment of ITP
In children, the disease often goes away without treatment; However, some may need it.
Adults usually start with an anti-inflammatory steroid. In some cases surgery is recommended to remove the spleen (splenectomy). This will increase the platelet count in about half of the patients. Today it is left as a residual treatment in the face of the emergence of other more effective types of drugs. Splenectomy involves the systematic vaccination of the patient against certain types of germs by causing marked humoral (antibody-mediated) immunosuppression.
If the disease does not improve, other treatments may be used, such as: injections with high doses of gammaglobulin (an immune factor), drugs that inhibit the immune system, imminent suppressors or monoclonal antibodies. Drugs that stimulate the production of platelets at the central or medullary level (Factor stimulant of megakaryocytic colonies). Filtration of antibodies outside the bloodstream (Plasmapheresis) and anti-RhD therapy for people with certain blood types.
People with Idiopathic Thrombocytopenic Purpura should not take acetylsalicylic acid (aspirin), ibuprofen or oral anticoagulants, as these drugs interfere with platelet function or blood clotting, and bleeding may occur.
Prognosis of ITP
With treatment, the probability of remission (symptom-free period) is good. Rarely, Idiopathic Thrombocytopenic Purpura can become a chronic condition in adults and reappear even after a period with no symptoms.
Complications of ITP
Sudden and severe bleeding from the digestive tract. Bleeding can also occur inside the brain.. It is important to go to the emergency room if there is heavy or evolving bleeding. Causes and risk factors are unknown, except in children where it may be related to a viral infection.