Idiopathic Thrombocytopenic Purpura (ITP) is the term used when the platelet count is low enough to cause very easy bruising. ITP has two basic origins: an autoimmune attack against platelets (primary or autoimmune ITP) and a bone marrow disorder (secondary ITP).
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]
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.
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]
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.
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