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What is ITP?
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Main > Specialty Areas > Hematology >
ITP (idiopathic thrombocytopenic purpura, immune thrombocytopenic purpura)

Conventional Treatments

There is no conventional cure for ITP. However, there are a number of treatments that usually help boost platelet levels out of the danger zone. Some of the most common ones are described below.

Steroids

The drug of choice for treating ITP is Prednisolone (or Prednisone), administered orally. The usual result is the gradual increase in the platelet levels. Also, prednisone helps strengthen walls of veins and arteries, which helps prevent unwanted bleeding. Slowly, over the course of weeks or months, the doze of Prednisolone is tapered off. For some people, the increase in platelet level becomes permanent, however for most the platelet count drops as the Prednisolone dosage is reduced. These people may require long-term low dose of the medication to keep their platelets at acceptable levels.

The problem with Prednisolone is its side-effects. They include water retention (which results in a puffy face), influences on mood, weight gain, irritation of gastro-intestinal tract and suppressed immune response. The longer you take it, the more likely the side-effects to grow in number and severity. So, if you are like most ITP sufferers, you'll eventually have to consider other treatments or alternative treatments.

A couple of other steroids that your doctor may prescribe for your ITP are Decadron (Dexamethasone) and Deflazacort - they are similar in effect (and side-effects) to Prednisolone and are listed here just for your reference.

Drug Info:
Prednisolone is a synthetic corticosteroid (it has nothing to do with pills that bodybuilders pop - those are anabolic steroids). Corticosteroids are hormones that are naturally produced by your body's adrenal glands and, among their other functions, control your body's immune system's inflammatory responses. Prednisolone is usually administered in much higher dozes than the corticosteroid levels produced by the body, hence the side effects.

Immunoglobulin (IVIg)

The treatment involves an intravenous administration of immunoglobulin solution. The type of immunoglobulin (which is a protein that contains antibodies normally found in human blood) that is used for treating ITP is IgG. Nobody knows precisely how the treatment works, but it is thought that it blocks platelet removal, and thus, increases their number. It is a very temporary treatment - it has to be repeated every 10 to 21 days to maintain adequate platelet counts.

The side effects are relatively rare and minor. Very rarely a severe anaphylactic reaction may occur, but the probability is one tenth of one percent. The solution is sterile and is tested for HIV and hepatitis. Because it usually succeeds in raising platelet count, albeit temporarily, it is often used to treat severe or chronic ITP. It is also used during pregnancy, because of the decreased risk to the health of the mother and the baby as compared with other treatments.

Anti-D antibodies (WinRho SDF)

This works in a similar fashion to IVIg. The treatment is also administered intravenously, short-term (effects last for about one month) and is only effective for people who are Rh positive (up to 85% of people are) and have a spleen. Unlike IVIg, it may not be suitable for some pregnant women. Occasionally, it results in long-term platelet count increase.

Splenectomy (The Removal of the Spleen)

Generally, doctors do not resort to splenectomy before trying at least a couple of rounds of Prednisolone treatment. Splenectomy is a surgical procedure where the spleen is removed. Since the destruction of platelets usually happens in the spleen, the removal of the spleen results in higher platelet counts. Splenectomy was used to treat ITP since the beginning of the 20th century and works for about two thirds of ITP sufferers. Since spleen plays an important role in cleaning the body of infection, people who undergo splenectomy are usually at a higher risk of infections and are vaccinated against some common ones.

The downside to the treatment (besides having your spleen removed) is that with time (after a few years, generally), a lot of people relapse and their platelet counts go down again. There is no reliable way to predict how effective a splenectomy would be for an individual person in the long term; however, some studies suggest that people aged 40 and below usually fare better.

Organ Info:
The spleen is an organ that is located on the left side of the abdomen and is involved in maintaining healthy immune system. It filters blood of bacteria, tumor cells and any other foreign material. About ten percent of population have an extra spleen, which is called an accessory spleen and is much smaller than the "main" one.

Other Treatments

There is a number of other drugs and treatments that doctors sometimes resort to. They differ in their effects, administration and side-effects. They include chemotherapy drugs, antibiotics, Danazol, Rituxan and immunosuppressant drugs. Check out other web resources in the links section for in-depth information on these and other treatments.

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Random Useful Tip:
Epinephrine shot
If you are known to have a severe anaphylactic reaction, carry an epinephrine (adrenaline) shot with you at all times. Pay attention to expiration date and replace it regularly: upon expiration, it loses its effectiveness.

Random Drug Info:
Acyclovir
Acyclovir is a medication that is used to treat herpes infections of the skin, lips and genitals, chicken pox and shingles. It comes in the form of ointments, tablets, capsules or liquids. It relieves pain and itchiness and promotes healing; however, it does not cure the condition. Possible (but not common) side effects include headaches, upset stomach, vomiting and diarrhea. Severe side effects, such as severe rash or itching, blood in the urine, stomach pain or fever are even less common, but require prompt medical attention.



 
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