Definition
Immune Thrombocytopenia ek autoimmune bleeding disorder hai jisme body ka immune system galti se apne hi platelets ko destroy kar deta hai.
Platelets blood clotting me help karte hain, isliye unki kami se excessive bleeding aur bruising hone lagti hai.
Epidemiology
● Common in young women & children.
● Acute ITP: mostly in children after viral infection.
● Chronic ITP: common in adults, especially females.
Causes / Risk Factors
● Autoimmune diseases (Systemic Lupus Erythematosus, Rheumatoid Arthritis).
● Viral infections (HIV, Hepatitis C, Epstein-Barr Virus).
● Certain medications (Heparin, Sulfa drugs).
● Post-vaccination or after viral fever.
● Idiopathic (unknown cause).
Pathophysiology
● Autoantibodies (IgG type) form against platelets.
● These antibody-coated platelets are destroyed by macrophages in the spleen.
● Platelet count falls below normal (<150,000/mm³).
● Reduced platelet lifespan → defective clot formation → bleeding tendency.
Symptoms
● Easy bruising (ecchymosis).
● Petechiae (tiny red/purple spots on skin).
● Nosebleeds (epistaxis).
● Gum bleeding.
● Heavy menstrual bleeding (menorrhagia).
● Prolonged bleeding from cuts.
● Fatigue, dizziness in severe cases.
● Rarely, internal bleeding (GI, brain hemorrhage).
Complications
● Intracranial hemorrhage (life-threatening).
● Gastrointestinal bleeding.
● Severe anemia due to chronic blood loss.
Diagnosis
● CBC: Low platelet count, other cell lines normal.
● Peripheral smear: Few platelets, large platelets present.
● Bone marrow examination: Normal or increased megakaryocytes (to rule out other causes).
● Autoimmune tests: ANA, Anti-platelet antibody test.
● Coagulation profile: Normal (to differentiate from DIC).
Treatment
Medical Management:
● Corticosteroids (Prednisolone): First-line therapy to suppress immune destruction.
● IV Immunoglobulin (IVIG): For rapid increase in platelet count.
● Immunosuppressive drugs: Azathioprine, Rituximab (for chronic/refractory cases).
● Splenectomy: If not responding to medicines (since spleen destroys platelets).
● Platelet transfusion: Only in severe bleeding or emergency.
Supportive Care:
● Avoid injury & trauma.
● Avoid aspirin or NSAIDs (they worsen bleeding).
● Treat underlying infection if present.
Nursing Management
● Monitor for signs of bleeding (skin, gums, stool, urine).
● Check vital signs regularly (for shock or internal bleeding).
● Provide soft toothbrush & avoid IM injections.
● Maintain bed rest during active bleeding phase.
● Educate patient to avoid contact sports & injury.
● Psychological support for chronic illness.
● Monitor response to therapy (platelet count).
Prevention
● Avoid unnecessary medications causing thrombocytopenia.
● Educate about vaccination & early reporting of bleeding.
● Infection control to prevent secondary triggers.
Prognosis
● Acute ITP in children → self-limiting (resolves in weeks).
● Chronic ITP in adults → requires long-term follow-up but manageable with treatment.
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