Serious Discussion : Low Platelet Disorders-ITP (immune thrombocytopenic purpura).

[SS2006]

My 5 year old niece diagnosed with ITP. Her parents sent her to hospital yesterday after discovering many bruises on her body. Doctor first suspected dengue, but today said it's ITP. The little girl is still quite active. I promised my SIL to find out more info on this. Can the forum doctor or anyone else help? Is this condition serious?

[Dino]

Hope this helps.

http://www.itppeople.com/aboutitp.htm

[SS2006]

Thanks Dino.

ITP in Children
"An observant parent's evidence may be disproved but should never be ignored"
Lancet 1:688, 1951 Anonymous

ITP in children is often considered a different disease than ITP in adults because it goes into remission more easily. According to Dr. Bussel, a children's ITP specialist in NYC, 80% of children become well again within 6 - 12 months. In most cases, their ITP goes away within the first two months, tends not to lead to other problems, and does not return. The most feared complication is intracranial hemorrhage, a bleed to the brain, like a stroke. Fortunately, this is rare, occurring in less than .5 to 1.0% of the cases.

However short or long the ITP timeframe is for a child, it is often difficult. The contents of this page is designed to help make the ITP journey easier.

[Dino]

A lot of resources if you google....here's one more...

http://www.itpsupport.org.uk/childhooditp.htm

[SS2006]

A lot of resources if you google....here's one more...

http://www.itpsupport.org.uk/childhooditp.htm
Yes, I'm aware of that. I was hoping for local case studies. Maybe Doc Alfred or Doc Zazu can help.

[alfred98]

Ok!!! Me not heamatologist leh but talk abit lor...As the name as Idiopathatic Thrombocytopenic Purpura suggest....Is unknow cause...maybe aquired or heredited...All still depends on the platlets count...If very low then had to be treated usually started with steroid and if cannot advance to chemotherapy lor...So usually started with Prednisolone...Some will go into remmision but some may be there for life long...Some ladies found this out during pregnancy...And risk of bleeding is very high during delivery.
The rest I need to study abit lor...:)

[SS2006]

Ok!!! Me not heamatologist leh but talk abit lor...As the name as Idiopathatic Thrombocytopenic Purpura suggest....Is unknow cause...maybe aquired or heredited...All still depends on the platlets count...If very low then had to be treated usually started with steroid and if cannot advance to chemotherapy lor...So usually started with Prednisolone...Some will go into remmision but some may be there for life long...Some ladies found this out during pregnancy...And risk of bleeding is very high during delivery.
The rest I need to study abit lor...:)
Ok, thanks. Just want to know recovery rate high or not?

[siewjang]

CAn summary a bit what is ITP? Issit low white blood cell?

[TK Ho]

CAn summary a bit what is ITP? Issit low white blood cell?

Dey SJ, u read the posts or not? :cheesy:

It means low platelet, caused by autoimmunity (platelets are destroyed by the body)

[shiruikage]

and wat is platelet? the thing that makes ur blood clot when there's a cut on ur skin?

[TK Ho]

and wat is platelet? the thing that makes ur blood clot when there's a cut on ur skin?

Correct shiruikage.

Basically our blood has red blood cell (to carry oxygen and carbon doxide), white blood cells (to fight infection) and platelets (to clot blood)

[shiruikage]

well, at least the meagre biology lessons mrs phang taught me din go to waste....yet.

[SS2006]

Dey SJ, u read the posts or not? :cheesy:

It means low platelet, caused by autoimmunity (platelets are destroyed by the body)
This autoimmunity thing is quite scary. A friend of mine has a son diagnosed with diabetes Type1 at age 9. No family history of diabetes. Their conclusion was it might be autoimmunity destroying the pancreas ability to form insulin.
That boy has quite poor health since birth. Always down with flu or fever etc...

[Dino]

Does it cause you to puff up like a balloon when you get this disease?
I know i got a friend, she said something about her imune system breaking down, she was skinny but when she got that disease, she puffed up because of medication. :(

[SS2006]

Does it cause you to puff up like a balloon when you get this disease?
I know i got a friend, she said something about her imune system breaking down, she was skinny but when she got that disease, she puffed up because of medication. :(
The steroid in the medication causes that.

[Dino]

The steroid in the medication causes that.

Sigh....yeah..my friend survive it but its hard on her. She was in Kuching and had to seek treatment in Singapore. I think she is ok now but it has taken a toll on her life. :(

[SS2006]

Sigh....yeah..my friend survive it but its hard on her. She was in Kuching and had to seek treatment in Singapore. I think she is ok now but it has taken a toll on her life. :(
Yeah, life is hard. We must be thankful of our good health.

[alfred98]

Sigh....yeah..my friend survive it but its hard on her. She was in Kuching and had to seek treatment in Singapore. I think she is ok now but it has taken a toll on her life. :(
Why sillpore loctor very good issit??? Typical Sarawakian leh!!!:mad:

[Dino]

Why sillpore loctor very good issit??? Typical Sarawakian leh!!!:mad:

Dunno....i think she went to KL...but end up with not much progress....so she had to find other alternatives.

[Lava Gal]

If patient has become steroid resistance, can go for IgG (immunoglobulin) infusion oso right?
I have a batchmate from F6 who's got ITT and is expecting now. hope she delivers well, without complications. she only found out about it during pregnancy...and is on steroids - which has made her puffy.

[alfred98]

If patient has become steroid resistance, can go for IgG (immunoglobulin) infusion oso right?
I have a batchmate from F6 who's got ITT and is expecting now. hope she delivers well, without complications. she only found out about it during pregnancy...and is on steroids - which has made her puffy.
Lava!!! Do some home work for shirlene... Tell her more on ITP....

Usually by steroid is ok liao but some resistance case we just observe the level and if no bleeding we transfused onli just before delivery and pray hard!!!
The non pregnant one usually spleenectomy will be helpful....:)

[Lava Gal]

I have to read up on paeds ITP...didn't know there was much difference :o
will get back on it next wk

[SS2006]

I have to read up on paeds ITP...didn't know there was much difference :o
will get back on it next wk
From the link Dino posted, it says paed ITP not so severe...recovery after 6-12 months?

[Lava Gal]

Shirlene...did u mention how old the child is?hope that he's not in the category prone to chronic ITP, then higher chances of remission, as dino said.

Read on...
more on ITP... (http://www.pediatriceducation.org/2005/01/18)

Idiopathic (immune) thrombocyopenia purpura (ITP) usually occurs in children 2-10 years with a peak between ages 2-5 years. Children usually present with sudden onset of petechiae, ecchymosis, purpura, epistaxis, hematuria or gastrointestinal hemorrhage (all bleeding disorders)They often are otherwise well and have a preceding minor viral illness. Physical examination usually shows only the presenting signs, but evidence of infection or malignancy must be carefully looked for.

The part u asked about, Shirl...
Most children (~90%) resolve within 6 months usually without sequelae. If it lasts longer than 6 months it is called chronic ITP.
Chronic ITP may resolve but this is less likely. Chronic ITP is more common in children <1 year and >10 years. Mortality from acute ITP fortunately occurs rarely and is usually due to central nervous system hemorrhage.

Laboratory testing usually shows isolated thrombocytopenia. The blood smear shows normal to increased platelet size and normal white and red cell morphology. Bone marrow examinations are often not done in typical cases but would have increased numbers of megakaryocytes.

Treatment may include careful observation, intravenous immunoglobulin, steroids and spleenectomy, and avoidance of precipitating medications. Children with atypical presentations, chronic thrombocytopenia, or children who will be treated with steroids, should have a bone marrow biopsy to rule out underlying malignancy or other causes of thrombocytopenia.

[SS2006]

[B][I]Shirlene...did u mention how old the child is?hope that he's not in the category prone to chronic ITP, then higher chances of remission, as dino said.

.
She's 4yrs 3 mths...so she's not in the category prone to chronic ITP. Is the condition genetic, i observed that my sons also do tend to get bruises easily. My niece is my husband's elder sis's child.

[Lava Gal]

Idiopathic means cause is unknown of...but there are many more differential/provisional diagnosis for this condition. as my lecturers put it, only idiots come up with idiopathis causes as the main diagnosis! its a diagnosis of exclusion...do relevant tests to rule out everything else.

So, for ITP & genetic linkage...i'm not sure. hmmm...might be some other platelet disorder. or clotting factors deficiency. Just found out about this: Congenital/inherited (e.g. TAR, Congenital Amegakaryocytic Thrombocytopenia [CAMT])
guess it'd be good to get a blood test for ur son, if u are worried

Maybe Lilian can confirm more bout the genetic part, as she's the specialist (tsk...dun see her around that much)

Thrombocytopenia is usually defined as platelet counts <150,000/mm2. It can be found because of easy bruising, bleeding or can be an incidental finding on a complete blood count done for other reasons. The differential diagnosis of thrombocytopenia includes:


Increased Platelet Destruction
Autoimmune hemolytic anemia - Evan's syndrome
Congenital cyanotic heart disease
Disseminated intravascular coagulation
Drug - quinine, penicillin, digoxin, anti-epileptics, indomethacin, heparin
Idiopathic (immune) thrombocytopenic purpura
Neonatal illumine thrombocytopenia
Infection
Hemolytic-uremic syndrome
Hyperplenism
Kasabach-Merit syndrome
Thrombotic thrombocytopenia purpura

Decreased Platelet Production
Bone marrow infiltration - e.g. leukemia, storage diseases, myelofibrosis, etc.
Bone marrow injury - infection or drugs - usually transient
Congenital megakaryocytic thrombocytopenia
Congenital bone marrow aphasia - i.e. Fanconi's anemia
Chromosome abnormalities - e.g. Trisomy 13, 18, 21, Turner Syndrome
Congenital platelet disorders - Weskit-Aldrich syndrome, May-Hegglin anomaly, Bernard-Soulier syndrome, Alport syndrome
Hereditary amegakaryocytopoiesis - usually associated with TAR syndrome (thrombocytopenia-absent radius syndrome)
Other
Pseudothrombocytopenia - caused by clumped platelets

[alfred98]

Wah bravo Lava!!! Good work....Me also learning from this....Hehe.:)

[SS2006]

Thank you very much,Dr Lava and Dr Alfred.

[siewjang]

:unsure: I get bruises easily too wor.

[LiLiaN]

move the general forum as serious discussion...

[TK Ho]

:unsure: I get bruises easily too wor.

bruises from what-lah?

[monay]

Wah bravo Lava!!! Good work....Me also learning from this....Hehe.:)
agree, good job dr lava.... :)

[jeanlau]

Thanks doc lava.That was an eye opener
Wow,didn't know that there were so many differential diagnoses!

[Lava Gal]

Wah bravo Lava!!! Good work....Me also learning from this....Hehe.:)

agree, good job dr lava.... :)

Thanks doc lava.That was an eye opener
Wow,didn't know that there were so many differential diagnoses!

:o u guys ah...dr doc pulak wif me...exactly 1 more year to go, dearies - if all goes well.

Anyway..its my pleasure. glad to be of help :)

jean> ya...there are many differentials to every symptom a patient presents with, wich sometimes makes me think the same approach shud be used in everyday life - as in think laterally/out of the box to view each situation & find solution for each problem

[SS2006]

:o u guys ah...dr doc pulak wif me...exactly 1 more year to go, dearies - if all goes well.

Anyway..its my pleasure. glad to be of help :)

jean> ya...there are many differentials to every symptom a patient presents with, wich sometimes makes me think the same approach shud be used in everyday life - as in think laterally/out of the box to view each situation & find solution for each problem
My niece test result should be out today. They are still monitoring her in hospital.

[monay]

My niece test result should be out today. They are still monitoring her in hospital.
hope all is well...

[Lava Gal]

My niece test result should be out today. They are still monitoring her in hospital.
hope she'll be able to go home soon...do keep us updated

[alfred98]

My niece test result should be out today. They are still monitoring her in hospital.
Shirlene!! which hospital and who's the doctor!!! Maybe I know him or her can help up mah...:)

[TK Ho]

Shirlene!! which hospital and who's the doctor!!! Maybe I know him or her can help up mah...:)

Wah, loctor, very wide network connection-leh.:p

[KoChun]

Guys, just a kind reminder. As this is a Serious Discussion thread, please minimize chatting unnecessary stuffs here, okay?

[jeanlau]

My niece test result should be out today. They are still monitoring her in hospital.
I do hope the results are good news.

[TK Ho]

I do hope the results are good news.

Ya-lor best wishes.

[SS2006]

Shirlene!! which hospital and who's the doctor!!! Maybe I know him or her can help up mah...:)
Test done ruled out most of the things...very high probability it's acute ITP. Alfred, i think it's Teluk Intan GH, Paed is a 31 yr old lady. My SIL says she's very good, can explain most things.

[alfred98]

Test done ruled out most of the things...very high probability it's acute ITP. Alfred, i think it's Teluk Intan GH, Paed is a 31 yr old lady. My SIL says she's very good, can explain most things.
Ok!! Then not need to pull anything lor....

[SS2006]

Ok!! Then not need to pull anything lor....
Thanks anyway, Alfred.

[SS2006]

My niece aldy discharged, very likely the condition is acute ITP.
Doc Lava, a few more question i would like to ask on behalf of my sil.
1)my niece treatment now is immunoglobulin, what is the actual function? Is it suppresing the immune system? Can you please explain?
2) During the daily blood test, the platelet count increase everytime but white blood cells decreases a little. The doctor says it's still within the acceptable limit. What causes the white blood cells to decrease?
3) The doctor said the condition may be onset by some drug or antibiotic she consumed before (or something like that, i'm not quite sure). So is there any
drug or antibiotic that ITP patient should avoid?

[alfred98]

Ehhhhh!! U ask Lava right..............:laugh:

[siewhaw]

3) The doctor said the condition may be onset by some drug or antibiotic she consumed before (or something like that, i'm not quite sure). So is there any
drug or antibiotic that ITP patient should avoid?

Yea, I want to know also is there any antibiotics or any vitamin supplement that will decrease the platelet? Some said the patient should also avoid unhealthy environment, i.e. try not to get near animals too often. Cannot rare dogs. 

[SS2006]

Ehhhhh!! U ask Lava right..............:laugh:
Doc Alfred answer also welcomed.:)

[alfred98]

Doc Alfred answer also welcomed.:)
Now tarik harga waiting for Lava!!!!:cool:

[Lava Gal]

dr alfred, go ahead 1st...a little engaged now, will come back later or tomolow

[Lava Gal]

I’m really really sorry for this late reply. surprised not much discussion has taken place since last time i came here. guess all bz ya.
therse Info given are from my limited knowledge, and some research. Here’s what I found:

My niece aldy discharged, very likely the condition is acute ITP.
Doc Lava, a few more question i would like to ask on behalf of my sil.
A little bit of recap on ITP treatment…

The treatment for idiopathic thrombocytopenic purpura (ITP), which is due to antibodies coating the platelets' surfaces and increasing their destruction, is different to that for other causes of thrombocytopenia. ITP is often divided into two different forms:
• acute (ie sudden onset) ITP, which usually follows a viral illness in a child
• chronic (long-lasting) ITP, more common in adults.
Acute ITP, particularly in children, may require no treatment, especially if the platelet count does not fall too low and there is little bleeding. It usually improves spontaneously and, in children at least, rarely recurs.

Doctors decide whether to treat idiopathic thrombocytopenic purpura (ITP) based on your bleeding symptoms and platelet count. When treatment is needed, medicines are often used, at least at first. Treatments used for children and for adults are similar.

1)my niece treatment now is immunoglobulin,
In your niece’ case, I suppose the platelet count is quiet low, coz treatment has been started
ITP in Children
The acute (temporary) type of ITP that occurs in children often goes away within a few weeks or months. Children with bleeding symptoms more than merely bruising (purpura) are usually treated. Milder cases in children may not need treatment other than monitoring and followup to be sure the platelet count returns to normal.

what is the actual function? Is it suppresing the immune system? Can you please explain?Nope…steroids (eg: prednisolone) suppress d immune system. Immunoglobulin is actually to improve/boost the immune system. Somehow, it increases platelet counts (counteract the thrombocytopenia which means thrombo = platelet, -cyto = cell, penia = poor/ deficiency.
POSSIBLY, immunoglobulin (Ig) binds to the antiplatelet antibody produced by patient’s body, thus reducing the number of platelets destroyed in spleen, due to mistaking of the platelets as foreign bodies.

Immunoglobulin

Immunoglobulins (antibodies) are the proteins made by the immune system of the body following exposure to a foreign protein, for example, a virus. If this foreign protein appears again in the body at a later date, then it is 'recognised' by the antibody which then activates the rest of the immune system.

Immunoglobulins take some days or weeks to be manufactured following exposure to a foreign protein but they can be pooled from donated human blood and, once purified, may be given by injection.

The particular type of immunoglobulin used for ITP is called Immunoglobulin G, or IgG for short. This is given intravenously over a number of days (usually two to five).

The precise action of IgG in ITP is unknown but it is thought to block platelet removal (mainly by spleen) and so increases their number. This treatment provides only a temporary response, so it is mainly of benefit in acute ITP.

Multiple courses may be given in chronic ITP when a temporary rise in platelets is desired or during pregnancy, as the risk to the baby is less than with other treatments.

2) During the daily blood test, the platelet count increase everytime but white blood cells (WBC) decreases a little. The doctor says it's still within the acceptable limit. What causes the white blood cells to decrease?personally, I cant comment on this said reduction in WBC count, as I don’t have details of the differential counts. WBC is a broad term for a number of different types of cells, eg: Neutrophils, Leukocyte, etc etc…generally, an increase in WBC occurs in case of infections. Maybe…the child is recovering from an underlying infection, which triggered the acute ITP in the first place – bringing the WBC level to decrease =)
Not really a cause to worry, as long as in normal range.
And it’s a cause to rejoice that the child is responding to Ig therapy, proven by the increasing trend of the platelet count.

3) The doctor said the condition may be onset by some drug or antibiotic she consumed before (or something like that, i'm not quite sure). So is there any
drug or antibiotic that ITP patient should avoid?Any medication that further reduce a patient’s platelet count, or has the side effect of causing bleeding should be stopped and avoided! This can help raise the platelet count or prevent bleeding. For example, aspirin and ibuprofen (NSAIDs) are common medicines that reduce platelet function. Warfarin & heparin, blood thinners (anticoagulants) should also be used used with caution.
If there’s any infection, it should be treated…as that itself can cause reduced number of platelets.

Shirlene, hope this info is of some help to u & SIL ya…most imporatantly, we want your niece to be able to be healthy & function as usual. Wish her all d best.

[SS2006]

Thanks lava, the info are most helpful. I have forwarded your previous replies to my SIL, and she found it more reassuring than her doc's explanation.:)

[Lava Gal]

glad to hear tat, Shirlene. tanx 2 availability of info on net & all...:)
hmmm, maybe sometimes drs are too bz tat they just explain abit, and patients/family are left semi-informed.
anyway, this teaches me always make sure my future pts understand their diasease, treatment, and outcome well...ahhh patient education is indeed of utmost inportance!

[SS2006]

glad to hear tat, Shirlene. tanx 2 availability of info on net & all...:)
hmmm, maybe sometimes drs are too bz tat they just explain abit, and patients/family are left semi-informed.
anyway, this teaches me always make sure my future pts understand their diasease, treatment, and outcome well...ahhh patient education is indeed of utmost inportance!
The doctor did try to reassure the parents, told them it's nothing to worried about, but my SIL too worried, want more opinions. Anyway, my niece platelet aldy increased to almost normal. Thanks Lava for your time and effort.

[Lava Gal]

yeeaaaa...happy that her treatment is working. now ur SIL must be much reassured dee :)
not a all, Shirlene. really my pleasure being able to help out.

[alfred98]

Well done Lava!!!!:)