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Thrombocytopenic Purpura

GENERAL INFORMATION:

What is thrombocytopenic purpura? Thrombocytopenic (throm-bo-si-to-PE-nik) purpura (PER-pu-rah) is a bleeding disorder where there are too few platelets in the blood. Platelets are blood cells that help stop bleeding by sticking together to form a clot. Thrombocytopenic purpura is also called immune or idiopathic thrombocytopenic purpura (ITP) and may affect women more often than men. Affected people may not know that they have ITP early in the disease. Signs of bleeding may develop slowly over a long period of time. ITP is often a mild disease, but there may be times that bleeding can be severe and life-threatening. Diagnosing and treating ITP as soon as possible is important in controlling your ITP.

What causes thrombocytopenic purpura? Caregivers do not exactly know what causes ITP. It is thought that problems in the body's immune system may cause ITP. The immune system is the part of the body that fights infection. Normally, the immune system makes antibodies or substances that destroy germs, such as virus and bacteria. With ITP, antibodies stick to the platelets, so that the spleen or liver mistakenly destroys them as well. Any of the following may trigger the immune system to cause ITP:

• Infection by a germ, called a virus.
  
  
• Medicines, such as antibiotics, blood thinners, and medicines for cholesterol or seizures.
  
  
• Vaccines, such as those for measles, mumps and rubella.

What are the signs and symptoms of thrombocytopenic purpura? Signs of ITP may include petichiae (pinpoint, reddish spots) and purpura (purplish flat areas of bruising). There may also be bleeding from the gums, mouth or nose. Stools (bowel movements) may be dark-colored or may have blood in them. Women with ITP may have heavy bleeding during their monthly periods.

How is thrombocytopenic purpura diagnosed? You may need the following tests:

• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• Bone marrow biopsy: This is when a sample of bone marrow is removed and sent to a lab for tests. Bone marrow is the soft, spongy tissue inside the bone. The skin over your upper hipbone is first cleaned. Caregivers put numbing medicine into your skin so you will have little pain. A bandage is put on the biopsy area after the tissue sample is taken.

How is thrombocytopenic purpura treated? Watchful waiting and frequent check-ups may be all that is needed if the ITP is mild. Caregivers may want to watch for changes in the number of your platelets before starting any treatment. They may also want to know the medicines you are taking. Bring a list or the bottles of your medicines with you when you see your caregiver. You may have one or more of the following:

• Immune globulins: Immune globulins can be used to treat many different problems. It may be given to help your immune system fight infection. It may also help if your body does not produce enough of certain kinds of blood cells. This medicine may help if your system fights something in your blood or body that it should not. Ask your caregiver for more information about how immune globulin medicine may help you.
  
  
• Steroids: Steroid medicine may be given to decrease inflammation, which is redness, pain, and swelling.
  
  
• Surgery: Surgery to remove the spleen may be done. This surgery is called a splenectomy. Ask your caregiver for more information about surgery as a treatment for ITP.

Your treatment may change if your signs and symptoms are not being controlled even after taking medicines. This may be decided by your caregiver after you have further tests. You may have any of the following if your signs and symptoms are not being controlled:

• Blood transfusion: During a blood transfusion, you will get whole blood, or parts of blood through an IV. Many people are worried about getting AIDS, hepatitis, or West Nile Virus from a blood transfusion. The risk of this happening is rare. Blood banks test all donated blood for AIDS, hepatitis, and West Nile Virus. If you refuse a blood transfusion, your condition may get worse, and you may die.
  
  
• Medicines: Additional medicines may be needed to treat your ITP. These may include immunosuppressants, chemotherapeutic agents, and hormones. Ask your caregiver for more information about other treatment options for ITP.

With treatment, such as medicine and surgery, you may have an improved quality of life.

What can I do to prevent bleeding?

• Wear a medical alert bracelet or necklace stating that you have thrombocytopenic purpura. You may get one from the local drugstore or contact the MedicAlert Foundation:
  • MedicAlert Foundation
    2323 Colorado Avenue
    Turlock, CA 95382
    Phone: 1-888-633-4298
    Web Address: http://www.medicalert.org
    
  
  
  
• Avoid playing contact sports. This may cause skin bruising and head injuries, which may lead to bleeding.
  
  
• Avoid taking medicines without your caregiver's OK. Aspirin, ibuprofen, and antihistamines may cause bleeding and should be avoided. Ask your caregiver before taking any medicines other than those he has given you.
  
  
• If you are having hard, dry stools that are difficult to pass, you may be constipated. Constipation may cause bleeding in your bowel movement (BM). Eat fresh fruit, high fiber foods, and plenty of water to avoid constipation. Ask your caregiver for more information about preventing and treating constipation.
  
  
• Use a soft-bristled toothbrush to prevent bleeding gums. Brush your teeth slowly and gently as this may prevent bleeding gums. Use lip balms to prevent your lips from drying and cracking.
  
  
• Use lotion on your dry skin. This may prevent itching and scratching, which may lead to bruising.

Where can I find support and more information? Having thrombocytopenic purpura may be a life-changing disease for you and your family. Accepting that you have thrombocytopenic purpura may be hard. You and those close to you may feel angry, sad, or frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. You may also want to join a support group for people who have thrombocytopenic purpura. Contact the following for more information:

• National Heart, Lung and Blood Institute
  Health Information Center
  P.O. Box 30105
  Bethesda, MD 20824-0105
  Phone: 1-301-592-8573
  Web Address: http://www.nhlbi.nih.gov/health/infoctr/index.htm
  

• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
  Building 31, room 9A04 Center Drive, MSC 2560
  Bethesda, MD 208922560
  Web Address: http://www.niddk.nih.gov
  

• American Academy of Family Physicians
  PO Box 11210
  Shawnee Mission, KS 66207-1210
  Phone: 1-913-906-6000
  Web Address: http://www.aafp.org
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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