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Immune Thrombocytopenic Purpura (ITP) is a disorder of the blood.

Immune refers to the immune system's involvement in this disorder.

Antibodies, part of the body's immunologic defense against

infection, attach to blood platelet, cells that help stop bleeding,

and cause their destruction. Thrombocytopenia refers to decrease in

blood platelet. Purpura refers to the purplish- looking areas of the

skin and mucous membranes (such as the lining of the mouth) where

bleeding has occurred as a result of decreased platelet.

Some cases of ITP are caused by drugs, and others are associated

with infection, pregnancy, or immune disorders such as systemic

lupus erythematosus. About half of all cases are classified

as " idiopathic, " meaning the cause is unknown.

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What Are the Symptoms of ITP? The main symptom is bleeding, which

can include bruising ( " ecchymosis " ) and tiny red dots on the skin or

mucous membranes ( " petechiae " ). In some instances bleeding from the

nose, gums, digestive or urinary tracts may also occur. Rarely,

bleeding within the brain occurs.

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How Is ITP Diagnosed? The physician will take a medical history and

perform a thorough physical examination. A careful review of

medications the patient is taking is important because some drugs

can be associated with thrombocytopenia. A complete blood count will

be done. A low platelet count will establish thrombocytopenia as the

cause of purpura. Often the next procedure is a bone marrow

examination to verify that there are adequate platelet-forming cells

(megakaryocyte) in the marrow and to rule out other diseases such as

metastatic cancer (cancer that has spread to the bone marrow) and

leukemia cancer of the blood cells themselves). Another blood sample

may be drawn to check for other conditions sometimes associated with

thrombocytopenia such as lupus and infection.

Acute and Chronic Form of Thrombocytopenic Purpura

Acute (temporary) thrombocytopenic purpura is most commonly seen in

young children. Boys and girls are equally affected. Symptoms often,

but do not necessarily, follow a viral infection. About 85 percent

of children recover within 1 year and the problem doesn't return.

Thrombocytopenic purpura is considered chronic when it has lasted

more than 6 months. The onset of illness may be at any age. Adults

more often have the chronic disorder and females are affected two to

three times more than males. The onset of illness may be at any age.

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How Is ITP Treated? If the doctor thinks a drug is the cause of the

thrombocytopenia, standard treatment involves discontinuing the

drug's use. Infection, if present, is treated vigorously since

control of the infection may result in a return of the platelet

count to normal.

The treatment of idiopathic thrombocytopenic purpura is determined

by the severity of the symptoms. In some cases, no therapy is

needed. In most cases, drugs that alter the immune system's attack

on the platelet are prescribed. These include corticosteroids (i.e.,

prednisone) and/or intravenous infusions of immune globulin. Another

treatment that usually results in an increased number of platelet is

removal of the spleen, the organ that destroys antibody-coated

platelet. Other drugs such as vincristine, azathioprine (Imuran),

Danazol, cyclophosphamide, and cyclosporine are prescribed for

patients only in the severe case where other treatments have not

shown benefit since these drugs have potentially harmful side

effects.

Except in certain situations, (e.g., internal bleeding and

preparation for surgery), platelet transfusions usually are not

beneficial and, therefore, are seldom performed. Because all

therapies can have risks, it is important that overtreatment

(treatment based solely on platelet counts and not on symptoms) be

avoided. In some instances lifestyle adjustments may be helpful for

prevention of bleeding due to injury. These would include use of

protective gear such as helmets and avoidance of contact sports in

symptomatic patients or when platelet counts are less than 50,000.

Otherwise, patients usually can carry on normal activities, but

final decisions about activity should be made in consultation with

the patient's hematologist.

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Where Can I Obtain Further Information on ITP? Blood specialists

(hematologists) are experts in the diagnosis and treatment of these

disorders. These doctors practice in most mid- and large-size

cities. A majority of medical centers have hematology divisions in

their medicine or pediatrics departments, and patients who need

evaluation, treatment, or information can often be referred there.

Additional information can be obtained from the National

Organization for Rare Disorders at P.O. Box 8923, New Fairfield, CT

06812; tel: (203) 746-6518.

U.S. Department of Health and Human Services

Public Health Service

National Institutes of Health

National Heart, Lung, and Blood Institute

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This e-text is not copyrighted. NIDDK encourages users to duplicate

and distribute as many copies as needed.

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NIH Publication No. 90-2114

September 1990

e-text last updated: 12 February 1998

Cary: I hope this helps.....Kathi in OK

> In a message dated 10/03/2004 20:38:24 Central Standard Time,

> bandit5125@y... writes:

>

>

> > the itp

>

> What does this mean? ITP? Cary

>

>

>

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Guest guest

Hello, Bandit, and welcome to the group! I'm very sorry to hear about

your RA and ITP diagnoses.

Do you know specifically what viral infection it was that your

physicians suspect triggered your RA?

I don't remember anyone here saying that they have drug-induced ITP, but

ITP comes up a lot in my reading.

How are you currently being treated? Prednisone? I'm not sure if you are

a good candidate, but have you considered trying staphylococcal protein

A immunoadsorption (Prosorba column) since it can be used to treat both

ITP and RA?

ITPPeople.com

" Prosorba Column Therapy " :

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

Aetna Clinical Policy Bulletin

" Extracorporeal Immunoadsorption (Prosorba column) "

http://www.aetna.com/cpb/data/CPBA0355.html

Rituxan (rituximab) is also under investigation for both ITP and RA:

ITPPeople.com

" Rituxan "

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

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

[ ] itp

> I am a newbie to this group. I have had ra for 4 years now.

> Developed from a viral infection. Since last feb (2003) I have

> developed an autoimmune disease called itp. My dr.s think it was

> brought on by the ra meds. I was on methotrexate, to name one, which

> we think brought out the itp. I am still struggling with the ra and

> the itp, and was wondering if any of you have experienced the same

> from the ra drugs.

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Guest guest

the reason I say they think it was brought on my methotrexate is

because my counts went up shortly after stopping the drug, but then

they crashed again. I have had a bmb and it did come back with some

damage, but my hemo in boston thinks that it may be able to

rejuvinate itself, I don't have a clue! I have started an intense

vitamin regime! it seems to be helping, will see what happens.

Anyone else here have these issues with itp?

I have been responding to s emails directly and not sure if

thats what I am supposed to do, and if its wrong I apologize.

you are more than welcome to copy and paste them and put them on

this board. Thanks for your help!

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