Itp

.

1. RATHEESH R.L IDIOPATHIC THROMBOCYTOPENIC PURPURA

2. DEFINITION Idiopathic thrombocytopenic purpura  ( ITP ) is a bleeding disorder in which the immune system destroys platelets, which are necessary for normal blood clotting. 

3. “Idiopathic” means the cause of the condition is not known. “thrombocytopenic” means there is a lower than normal number of platelets in the blood “ purpura ” refers to purple bruises caused by bleeding under the skin

4. TYPES There are two types of ITP Acute ITP Chronic ITP

5. ACUTE ITP Acute ITP is the most common form of the disorder. It usually lasts less than six months and mainly occurs in children . Mainly caused b infections with viruses.

6. CHRONIC ITP Chronic ITP lasts six months or longer. It’s most commonly seen in adults, although teenagers and younger children can be affected . It does not need treatment if the platelet level does not pose a risk of bleeding

7. ETIOLOGY AND RISK FACTORS The word “idiopathic” means “of unknown cause.” This means the exact cause of ITP hasn’t been identified.

8. Other risk factors are Autoimmune disorders like SLE Among children Viral infections such as mumps or flu Among adults viral infections such as rubella and chicken pox Use of drugs like sulfa drugs Exposure to insecticides and chemicals pregnancy

9. CLINICAL MANIFESTATIONS Some people with ITP have no symptoms . The most common symptoms of ITP are: bruising easily pinpoint-sized petechiae , often on the lower legs spontaneous nose bleeds bleeding from the gums (for example, during dental work)

10. blood in the urine blood in the stool abnormally heavy menstruation prolonged bleeding from cuts profuse bleeding during surgery

11. DIAGNOSIS History collection and physical examination In the physical examination should evaluate for the signs of bleeding under the skin, and will ask about the previous illness and the types of medications and supplements that recently taken

12. Complete blood count The RBC, WBC and platelet count should be evaluated. RBC & WBC will be normal but the level of platelet will be decreased.

13. Blood smear test a sample of blood is placed on a slide and observed under microscope . This test is often used to confirm the number of platelets.

14. Bone marrow examination it is to identify, whether the decreased number of platelet is because of the abnormalities in the bone marrow.

15. MANAGEMENT The goal of treating ITP is to ensure a safe platelet count and prevent bleeding complications while minimizing treatment side effects.

16. Among children ITP usually cures without any treatment 80% of children with ITP recover completely within 6 months

17. Adults with mild cases of ITP requires monitoring and regular platelet checking. But if the symptoms are worsening, treatment is necessary.

18. Corticosteroids The doctor may prescribe a corticosteroid, such as  prednisolone , which can increase the platelet count by decreasing the activity of the immune system.

19. Intravenous Immune Globulin (IVIG) If bleeding has reached a critical level or the patient is going to have surgery and need to increase the platelet count quickly, so the patient may be given intravenous immune globulin (IVIG).

20. Thrombopoietin Receptor Agonists Thrombopoietin receptor agonists, including romiplostim and eltrombopag . it help to prevent bruising and bleeding by causing the bone marrow to produce more platelets.

21. Immuno suppressants Immuno suppressants inhibit the activity of the immune system. They include: Rituximab  ( Rituxan ) C yclophosphamide  (Cytoxan) A zathioprine  (Imuran, Azasan )

22. Platelet transfusions: The platelet transfusion is required when the level of platelets is decreasing.

23. Antibiotics Some people with ITP are also infected with  Helicobacter pylori , which is the same bacteria that causes most peptic ulcers. Antibiotic therapy to eliminate  H. pylori  has helped increase platelet counts in some people.

24. Surgery If the patient have severe ITP and medication doesn’t improve the symptoms or platelet count, the doctor may advise surgery to remove the spleen . This is called a spleenectomy .

25. Lifestyle Changes Avoid certain over-the-counter drugs that can affect platelet function, including aspirin, ibuprofen (Advil, Motrin), and the blood-thinning medication  warfarin (Coumadin) . Limit your intake of alcohol because consuming too much alcohol can adversely affect blood clotting .

26. Choose low-impact activities instead of competitive sports or other high-impact activities to decrease your risk of injury and bleeding .

27. NURSING MANAGEMENT Protect the patient from trauma, keep the side rails up. Instruct avoid brushes and blades promote the use of electric razors and soft tooth brush Avoid invasive procedures such as venipuncture and urinary catheterization

28. Monitor platelet count daily and watch for bleeding Warn the patient to avoid the use of aspirin Advice the patient to avoid straining during defecation and coughing Administer stool softners to prevent constipation