 |
 |
 |
|
Idiopathic Thrombocytopenic Purpura (ITP) is the term used when the platelet count is low enough to cause very easy bruising. IDP has two basic origins: an autoimmune attack against platelets (primary or autoimmune ITP) and a bone marrow disorder (secondary ITP).
Causes & Development
Primary ITP. The bone marrow produces platelets as fast as usual (at least in the early stages of the disease), but even before they have a chance to mature, they are taken out of circulation. An IgG antibody attaches to the platelets and marks them to be removed from circulation. It is likely that individuals who suffer this disease have a genetic propensity to autoimmunity and that a viral disease triggers it. Many autoimmune disorders have this characteristic.
Primary (or 'autoimmune') thrombocytopenia occurs mostly in children and young adults (typically before age 30), though it can rarely occur later in life. Many times, it manifests as an acute disease, lasting a few weeks and then clearing up completely. It might recur again later after another viral infection or with reactivation of a chronic virus, but eventually it ceases to be a problem in the majority of children who experience it.
Secondary ITP. This condition involves a defect in the production of platelets by the bone marrow that can occur as part of a general bone marrow dysfunction, in which both red and white blood cells are also produced insufficiently. It can occur secondary to leukemia, in which the stem cells that yield white blood cells proliferate and crowd out the stem cells that produce platelets and red blood cells (yielding high white cell count and low RBC and platelet counts). Secondary ITP can also occur as the result of chemotherapy treatments.
Some chronic diseases that affect the immune system - such as HIV, hepatitis C or systemic lupus - may yield a combination of inhibited platelet production and shortened time that platelets persist in the blood, resulting in ITP. Because in this case it is some other factor (disease process or medical treatment) that is causing the clinical result, this type of platelet deficiency is termed secondary ITP and may be resolved by stopping this other factor.
British researchers have confirmed that the measles-mumps-rubella (MMR) vaccine can cause this bleeding disorder in children. However, ITP can also occur in children following the viral infections the vaccinations were intended to prevent. The risk of post-vaccination ITP is quite low when compared to ITP that occurs after catching measles, rubella or mumps. For instance, one case of ITP occurs for about every 3000 rubella infections. [Archives of Disease in Childhood March 2001; 84: pp.227-229]
Treatment & Prevention
Conventional treatment is often aimed at inhibiting the immune system with corticosteroids such as prednisone. Because the spleen filters the platelet-immune complex it may be necessary to remove it in order to reduce the production of anti-platelet antibodies and slow the clearance of platelets from the system. In some people, however, more platelets are destroyed in the liver than in the spleen and in this case removing the spleen is less likely to result in remission. Note that after the spleen has been removed and the platelet levels elevated, the liver can take over the removal function and the platelet count can drop again.
The acute manifestation can usually be controlled by a course of therapy using steroids to inhibit the immune response for a period of several weeks. Chronic autoimmune thrombocytopenia develops in a small percentage of patients. In that case, steroid therapy eventually fails (due to the side-effects from prolonged administration). Until recently, the main therapy for chronic autoimmune thrombocytopenia has been splenectomy, which is sometimes curative and at the very least reduces the disease severity.
More recently, intravenous infusion of normal IgG to replace the body's anti-platelet IgG has been tried with some success and may replace splenectomy for some patients. This has also been proposed as an alternative to the initial therapy with prednisone. Other therapies are also being developed.
|
|
 |
|
 |
Signs, symptoms & indicators of A Low Platelet Count:
Risk factors for A Low Platelet Count:
A Low Platelet Count suggests the following may be present:
Recommendations and treatments for A Low Platelet Count: | | | | | Botanical |  Herbal Combinations | In China, primary ITP is the main subject of reports suggesting that Chinese herbs - but not acupuncture - will raise the platelet levels in patients with persistent ITP, often to an acceptable level although only rarely to the normal range. According to the clinical reports, the use of herbs will often raise the platelets from the unacceptable level (below 50, at which bleeding that is difficult to stop may occur) to an average of about 75-85. Normal platelet levels are usually defined as 150 or above. Some patients described in the literature had their platelet levels reach over 100 and a small number attained a completely normal level.
A Chinese formula used for IDP contained: astragalus, codonopsis, tang-kuei, moutan, agrimony, isatis leaf, perilla stem, licorice, raw rehmannia, cooked rehmannia and eclipta. The trial group of 36 patients receiving this formula ranged in age from 13-60 years. Treatment time was at least three months and it was reported that all but 3 of the patients had improvement of symptoms. The average increase of platelets was from 38 to 79, and the average decrease in IgG was from 74 to 32. [Shanghai Journal of Traditional Chinese Medicine 1991; (3): pp.1-3] |
|
Vitamins |
 Vitamin E| | Five patients with thrombocytopenic purpura received 200-400mg of alpha-tocopherol acetate daily. Within 7-14 days, platelet counts and capillary fragility returned to normal or near normal. [Science 163: 762, 1946)] Note, however, that vitamin E is known to increase bleeding tendency by reducing platelet aggregation, so higher doses may be contraindicated for some patients. |
|
| | | | |
KEY | | Weak or unproven link |  | | Strong or generally accepted link |  | | Proven definite or direct link |  | | Very strongly or absolutely counter-indicative | | | May do some good | | | Highly recommended |
GLOSSARY
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Antibody (Antibodies)
A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.
Autoimmune Disease (Autoimmune, Autoimmunity)
One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.
Bruise (Bruised, Bruising)
Injury producing a hematoma or diffuse extravasation of blood without breaking the skin.
Capillary
Any of the smallest blood vessels connecting arterioles with venules and forming networks throughout the body.
Chemotherapy
A treatment of disease by any chemicals. Used most often to refer to the chemical treatments used to combat cancer cells. Chemotherapy is usually given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on. Most anticancer drugs are given by injection into a blood vessel (IV); some are given by mouth. Chemotherapy is a systemic therapy, meaning that the drugs enter the bloodstream and travel throughout the body. Usually, a patient has chemotherapy as an outpatient (at the hospital, at the doctor's office, or at home). However, depending on which drugs are given and the patient's general health, a short hospital stay may be needed.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Corticosteroid (Corticosteroids)
Steroid hormone produced by the adrenal cortex.
Hepatitis C
Caused by an RNA flavivirus. Transmission is predominantly through broken skin on contact with infected blood or blood products, especially through needle sharing. Sexual transmission is relatively rare. Symptoms are almost always present, and very similar to those for Hepatitis B: initially flu-like, with malaise, fatigue, muscle pain and chest pain on the right side. This is followed by jaundice (slight skin yellowing), anorexia, nausea, fatigue, pale stools, dark urine and tender liver enlargement, but usually no fever.
Herbs (Herb, Herbal)
Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with one teaspoon herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Tinctures may be used singly or in combination as noted. The high doses of single herbs suggested may be best taken as dried extracts (in capsules), although tinctures (60 drops four times per day) and teas (4 to 6 cups per day) may also be used.
Human Immunodeficiency Virus (HIV)
A retrovirus associated with onset of advanced immunodeficiency syndrome (AIDS).
Idiopathic
Arising spontaneously or from an obscure or unknown cause.
Immune System (Immune Response, Immunity)
A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation. The process may involve acquired immunity (the ability to learn and remember a specific infectious agent), or innate immunity (the genetically programmed system of responses that attack, digest, remove, and initiate inflammation and tissue healing).
Leukemia
Cancer of the lymph glands and bone marrow resulting in overproduction of white blood cells (related to Hodgkin's disease).
Liver (Hepatic)
The largest and one of the most complex organs of the body, the liver is responsible for much of the metabolism of fats, proteins and carbohydrates. It is the site of much of the body's detoxification. It is connected very closely with digestion and the regulation of blood sugar, among many other functions. Found behind the ribs on the right side of the abdomen, it has many important functions such as removing harmful material from the blood, making enzymes and bile that help digest food, and converting food into substances needed for life and growth. Hepatic: Pertaining to the liver.
Millimeter (Millimeters, mm)
A metric unit of length equaling one thousandth of a meter, or one tenth of a centimeter. There are 25.4 millimeters in one inch.
Platelet Aggregation
Platelets are the small, rather uniform fragments of large bone marrow cells that aid the blood in coagulation, hemostasis, inflammation, and thrombus formation. Mild subclotting and sticking is a common early condition that can lead to thrombosis, atherosclerosis, and strokes, and can be helped by an aspirin a day, better fat digestion, and Ceanothus.
Platelets (Platelet)
Cells that help the blood to clot.
Purpura
Bleeding into the tissues directly beneath skin or mucous membranes yielding a bruise or many red or purple petechia (flat, pin-head sized spots).
Red Blood Cell (Erythrocyte, Erythrocytes, RBC, Red Blood Cells)
Any of the hemoglobin-containing cells that carry oxygen to the tissues and are responsible for the red color of blood.
Spleen (Splenectomy)
The largest organ of the lymphatic system in the body, located between the stomach and the diaphragm (the muscle below the lungs which provides the motion for breathing). It destroys old red blood cells, produces lymphocytes and plasma cells, and stores blood. It also has other as yet unknown functions. A splenectomy is the surgical removal of the spleen.
Steroid (Steroids)
Any of a large number of hormonal substances with a similar basic chemical structure containing a 17-carbon 14-ring system and including the sterols and various hormones and glycosides.
Thrombocytopenia
Condition of abnormally small number of platelets circulating in the blood, characterized by inability to properly clot blood and easy bruising.
Virus (Viri, Viruses)
Any of a vast group of minute structures composed of a protein coat and a core of DNA and/or RNA that reproduces in the cells of the infected host. Capable of infecting all animals and plants, causing devastating disease in immunocompromised individuals. Viruses are not affected by antibiotics, and are completely dependent upon the cells of the infected host for the ability to reproduce.
Vitamin E
An essential fat-soluble vitamin. As an antioxidant, helps protect cell membranes, lipoproteins, fats and vitamin A from destructive oxidation. It helps protect red blood cells and is important for the proper function of nerves and muscles. For Vitamin E only, 1mg translates to 1 IU.
White Blood Cell (WBC, White Blood Cells)
A blood cell that does not contain hemoglobin: a blood corpuscle responsible for maintaining the body's immune surveillance system against invasion by foreign substances such as viruses or bacteria. White cells become specifically programmed against foreign invaders and work to inactivate and rid the body of a foreign substance. White blood cells are composed primarily of neutrophils, monocytes and lymphocytes. Lymphocytes are either T-cells or B-cells. T-cells (CD3 cells) are divided into T-helper (CD4 cells) and T-suppressor/cytotoxic (CD8 cells) cells.
Last updated: Nov 14, 2009
|
 |
|
|
