In Acute ITP, your own immune system enjoys an arcade game of “shoot the platelets” , as a result platelet counts can drop precipitously – I have seen them reported down to zero to 1 ! When I see a patient of Immune thrombocytopenic purpura (ITP), it reminds me of a smiling Julia Roberts suffering from it , since these patients otherwise may not look or feel very sick or toxic, unlike low platelet conditions like DIC, TTP / HUS, Acute leukemias, etc. But make no mistake, it’s still risky and needs treatment- the risk of major or fatal bleeding from minor injuries and spontaneous bleeds, however what alerts most patient is a fine petechial rash or easy bruising making them look like a mini-polka dot garment.
Something sets these platelets up to suddenly fall out of love with immune system. The common theory is a trigger that causes molecular coating on these platelets making them look suddenly foreign. An excellent way recall causes/triggers of Acute ITP is ‘A-ITP‘ :
A – Autoimmune conditions like SLE, RA, Crohn’s, etc.
I – Infections including H-pylori, Immunizations , Immune-deficiencies like HIV, CVID, IgA Deficiency
T – Therapeutic medications, Tumors like Lymphoma/leukemias, herbal Teas & other supplements
P – Pregnancy
To remember the treatment (Rx) options for ITP, I use ‘ITP-Rx‘
I – IVIG
T – Thrombopoetin-Receptor Agonists (TPO-RAs), Transfuse platelets if active bleeding
P – Prednisone or Decadron or IV Methyl-Prednisone (steroids)
R – Rituximab
X – reminds you cutting (scissors ✂ ) ? = Splenectomy !!
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P.S: I am gonna have a small drink of wine tonight – since this was the 100th post published on this blog ! Cheers ! 🍷
