Idiopathic Thrombocytopenic Purpura

Overview of Idiopathic Thrombocytopenic Purpura (IDP)

Generally, Two distinct clinical syndromes manifest as an acute condition in children and a chronic condition in adults. Additionally, the acute form often follows an infection and spontaneously resolves within two months. In detail, Chronic immune thrombocytopenia persists longer than six months with a specific cause being unknown.

Furthermore, ITP is an autoimmune disease with antibodies detectable against several platelet surface structures.

Besides this, ITP is diagnosed by identifying a low platelet count on a complete blood count (a common blood test). However, since the diagnosis depends on the exclusion of other causes of a low platelet count, additional investigations (such as a bone marrow biopsy) may be necessary in some cases. [1]

Indian epidemiology then other

Causes of Idiopathic Thrombocytopenic Purpura (IDP)

1. Decreased platelet production Hypoplasia of megakaryocytes i.e.

• Chlorothiazide, also ethanol
• A megakaryocytic thrombocytopenia

2. Increased platelet destruction
3. Idiopathic Immune thrombocytopenia
4. Secondary

(i) Immune mechanisms i.e.

• Collagen vascular disease
• Lymphoproliferative disorders
• SLE
• Drug-induced Diclofenac Isoniazid Digoxin Quinine Tamoxifen Gold salts Heparin Glibenclamide

(ii)non-immune mechanisms i.e.

• DIC
• Acute leukaemia
• TIP
• Myelosuppressive drugs
• Aplastic anaemia
• Cyclophosphamide, also busulphan, etc.

3.Abnormal pooling of platelets i.e.

• Splenomegaly, congestive, also neoplastic

4.Other causes

• Hepatitis
• Malignancy
• Pregnancy
• HIV infection
• Infectious mononucleosis
• Parvovirus

Risk factors are things that make you more likely to develop a disease in the first place.

Pathogenesis refers to the development of a disease. It’s the story of how a disease gets started and progresses.

This is the entire journey of a disease, encompassing the cause but going beyond it.

Pathophysiology, on the other hand, focuses on the functional changes that occur in the body due to the disease. It explains how the disease disrupts normal physiological processes and how this disruption leads to the signs and symptoms we see.

Imagine a car accident. Pathogenesis would be like understanding how the accident happened – what caused it, the sequence of events (e.g., one car ran a red light, then hit another car). Pathophysiology would be like understanding the damage caused by the accident – the bent fenders, deployed airbags, and any injuries to the passengers.

In simpler terms, pathogenesis is about the "why" of a disease, while pathophysiology is about the "how" of the disease’s effects.

Classification of Idiopathic Thrombocytopenic Purpura (IDP)

1. Acute thrombocytopenia
2. Chronic ITP

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Sign & Symptoms of Idiopathic Thrombocytopenic Purpura (IDP)

Acute thrombocytopenia i.e.–

If severe and of sudden onset, may cause widespread purpura, bruising, mucosal bleeding, cerebral and GI hemorrhage. Moreover, Fundal hemorrhage, persistent headache and other signs of increasing intracranial pressure suggest intracranial bleeding. In detail, Children with acute thrombocytopenia are at less risk than adults. When the condition develops after viral infection, e.g. measles, EBV infection, the duration is brief, active treatment is not required also recovery is nearly always complete.

Chronic ITP i.e.

In brief, It is most common in young adults, especially women. Most patients have purpura, epistaxis, also often menorrhagia. Symptoms tend to fluctuate, with fairly long remissions as well as periods when symptoms increase spontaneously. Commonly occur after a viral infection. Lastly, Table 25 compares features of acute ITP and chronic ITP.

Severity of bleeding in ITP is determined by platelet count. [1]

Platelet count and severity of bleeding in ITP.

1. Firstly, Platelet count is > 50 No spontaneous bleed
2. Secondly, If Platelet count is 10-50 Bleeding in skin and mucus membranes
3. Thirdly, Platelet count is < 10 post-traumatic bleeding, serious GI, and genitourinary bleeding.

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Diagnosis of Idiopathic Thrombocytopenic Purpura (IDP)

1. Blood Thrombocytopenia Hb decreased Antiplatelet antibodies
2. Bone marrow i.e.

• Megakaryocytic hyperplasia
• Non-functioning megakaryocytes. Additionally, Absence of budding of platelets from cytoplasm
• Erythroid hyperplasia due to anaemia
• Iron stores diminished, if severe bleeding is one of the features

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

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Treatment of Idiopathic Thrombocytopenic Purpura (IDP)

Conservative treatment

[a] Bleeding not severe i.e.–

Wait and see policy especially in children and young women up to the age of 25, because spontaneous remission, often permanent occurs in number of patients. Moreover, Initiate treatment when PCT <30,000

[b] Severe bleeding i.e.–

(i) Blood transfusion.

(ii) Prednisolone – 40 mg a day for 2 weeks.

• Sometimes permanent remission. Observe patient at intervals for next 12 months.
• If purpura disappears either partially or completely but platelet count remains low, 5-15 mg. of prednisolone daily for a further period of at least 3 months in the hope that permanent remission will occur.

Immunosuppressive therapy

Drugs such as azathioprine or cyclophosphamide are sometimes used in patients who are refractory to splenectomy and steroids or develop relapse.

Immunoglobulin preparations

• IV infusions of large doses result in reticuloendothelial blockade, and may be warranted in life-threatening situation.

Rituximab weekly in doses of 375 mg/m2 can produce remission for a period of time.

TPO receptor agonists – Romiplostim (given subcutaneously) and another orally eltrombopag (given orally) effective in raising  platelet counts in patients with ITP and are recommended for adults at risk of bleeding who relapse after splenectomy or who have been unresponsive to at least one other therapy, particularly in those who have a contraindication to splenectomy. [1]

1. Splenectomy – Indications –

(a) Chronic cases, particularly adults, who have not had sustained response to steroids, and in whom troublesome bleeding persists after 6 months.

(b) Symptoms severe and platelet count very low.

(c) Signs of incipient central nervous system hemorrhage.

(d) Girls approaching age of onset of menstruation.

(e) Young married women likely to become pregnant.

(f) First 5 months of pregnancy.

(g) Steroid refractory

Pregnancy

Anti-platelet auto antibodies in a pregnant woman with ITP will attack the patient’s own platelets and will also cross the placenta and react against fetal platelets. Therefore, ITP is a significant cause of fetal and neonatal immune thrombocytopenia. [1]

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Homeopathic Treatment of Idiopathic Thrombocytopenic Purpura (IDP)

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Idiopathic Thrombocytopenic Purpura (IDP)

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy.

Bothrops Lanciolatus:

• The venom of this snake is most coagulating; therefore, it is expected to be useful in thrombosis and thrombotic affections as hemiplegia.
• Aphasia, without the affection of tongue. Nervous trembling. In detail, Great lassitude and sluggishness.
• Blindness from hemorrhage into retina. Moreover, Day blindness can scarcely see her way after sunrise.
• Paralysis of one arm or one leg only.
• Besides this, Slight shivering, followed by profuse sweat.
• All in all, Intolerable pain in the big toe. Bone becomes bare from gangrene and becomes necrotic. Worse right side. [2]

Crotalus Horridus

• Rattle snake poison especially affects blood; heart; liver.
• Basically, It produces profound nervous shock; with deathly sickness, trembling and prostration.
• Furthermore, Easily tired by slight exertion. Paralysis; post- diphtheritic, of the out of control.
• It causes disorganization of blood and tissues.
• Hemorrhages are slow, oozing, of dark thin blood not clots; from all the orifices; also surfaces esp. from pharynx. Additionally,  Bloody pus, sweat.
• Tissues rapidly decompose producing putrid also malignant condition.
• Dark or bluish parts. Septic conditions, tonsils; goiter, ulcers, abscesses, blood boils. Petechiae. Gangrene.
• Besides this, Neuralgia as a sequel to sepsis. Chronic biliousness, climacteric conditions. Fainting’s. In detail, Convulsions; epilepsy, with trembling of the limbs, foaming at the mouth, violent cries, delirium. Plague. Yellow fever. Jaundice. General burning. Mouldy odours; of secretions.
• Lastly, Sclerosis; multiple, lateral. Progressive muscular atrophy. Suitable in broken down constitutions, and for old age nutritional troubles. Ill effects especially, of fright; sun; lightning; foul water; noxious effluvia. Affects specifically the right side. Oedema either general or of affected part.

Secale Cor

• A vegetable nosode called ergot, contracts the muscles of blood vessels and uterus, decomposes the blood; additionally producing hemorrhage which is thin, fetid, watery, black, oozing continuously.
• Twitching’s; spasms, with fingers spread apart. Gnawing and cramps; with stiffness; in single parts or after the pains.
• Moreover, Insufferable tingling, crawling, starting in face; or back; in the limbs; in finger tips, better rubbing. Sensation of burning in the whole body or as of sparks falling on them, or here and there; like fire.
• Discharges are dark, thin, foul also exhausting. Tetanic spasms with full consciousness. Additionally, Rapid emaciation; of paralyzed part; or with much appetite and excessive thirst.
• Loss of power of voluntary motion. Feels as if walking on velvet. Coldness; but does not want to be covered up. Convulsive jerks also starts in the paralyzed limbs.
• Neuralgia caused by pressure of distended veins. Varicose. Thrombosis. Lymphoid tumors. Sensation of deadness; in any part. Gangrene; traumatic; specifically from application of leeches or mustard, better cold.
• It is suited to irritable plethoric subjects; or to thin, scrawny, feeble women of cachectic appearance; to very old decrepit persons. Petechiae. Small wounds bleed much. Everything feels loose and open.
• Besides this, Contracted arterioles. Chronic, sharp, stinging neuralgic pains, which burn like fire better application of heat. In detail, Paralysis; with distorted limbs; of lower extremities; of one side; of one arm or one leg; with tingling, numbness and prickling.
• Paralysis after spasms. Restlessness, extreme debility; also prostration. Collapse.[2]

Phosphorus

• Phosphorus causes inflammation also degeneration of the mucous membrane of stomach and bowels; inflames the spinal cord and nerves; causing paralysis; disorganises the blood; causing fatty degeneration of blood vessels also every tissue and organ of the body; thus it produces a picture of destructive metabolism.
• It is suited to those young people who, grow rapidly and inclined to stoop.
• Chorea of children who grow too fast. Additionally, Tall, slender persons of sanguine temperament; nervous weak delicate persons who like to be magnetized.
• Insidious onset, gradually increasing debility, ending either in severe or rapid disease.
• Hemorrhage, recurrent, vicarious; small wounds bleed much. Blood streaked discharges. In detail, Purpura haemorrhagica.
• Recurrent effects colds, croups etc. Great susceptibility to external impressions, light, sound, odour, touch; electrical changes, etc.
• Suddenness of symptoms; sudden; prostration, faints; weak spells, sweats, shooting pains. Uncertain involuntary acts. Emptiness; in chest, stomach etc. Tightness ; in chest, cough etc.
• Pain or soreness in spots. Paralysis; pseudo-hypertrophic of muscles; of out of control, internal; throat, rectum.
• Internal, itching; tickling; throbbing here also there.

Other symptoms

• Burnings. Jerking; localized; subsultus. Joints; stiff, with little pain; sprains; easily dislocated; weak spells in joints, worse exertion.
• Symptoms due to heart also lung affections. Caries; of the bones; spine; upper jaw.
• Hard swelling here and there. Osteomyelitis. Exostoses. Bone fragility. Polyp; easily bleeding. Jaundice, as a concomitant, hematogenous. Hemophilia. Polycythemia. Erectile tumours. Pyemia. Acidosis. Phthisical habit. Emaciation.
• Spasms on the paralyzed side. Epilepsy with consciousness. Petit mal.
• Totters while walking. Human barometer. Flabby muscles.
• Ill effects of anger, fear, grief; worry; exposure to drenching rains; washing clothes; tobacco; having hair cut. Iodine.
• Excessive use of salt. Healed wounds break out again and bleed. Lipoma. Cancer [2]

Diet & Regimen  of Idiopathic Thrombocytopenic Purpura (IDP)

• Avoid Injury
• Avoid Drugs such as Aspirin, Ibuprofen
• Quick Management of Infection

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References use for Article Idiopathic Thrombocytopenic Purpura (IPD)

[1]Harrison-s_Principles_of_Internal_Medicine-_19th_Edition-_2_Volume_Set

[2] Concise Materia Medica of Hom. Remedies By S.R. Phatak

Frequently Asked Questions

What is Idiopathic Thrombocytopenic Purpura?

Idiopathic thrombocytopenic purpura or immune thrombocytopenia also known as Immune thrombocytopenic purpura (ITP), is a type of thrombocytopenic purpura defined as an isolated low platelet count with a normal bone marrow in the absence of other causes of low platelets.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Idiopathic Thrombocytopenic Purpura?

• Bothrops Lanciolatus
• Crotalus Horridus
• Secale Cor
• Phosphorus

What causes Idiopathic Thrombocytopenic Purpura?

• Decreased platelet production Hypoplasia of megakaryocytes
• Abnormal pooling of platelets
• Hepatitis
• Malignancy
• Pregnancy
• HIV infection

What are the symptoms of Idiopathic Thrombocytopenic Purpura?

• Purpura
• Bruising
• Mucosal bleeding
• Cerebral
• GI hemorrhage

Give the types of Idiopathic Thrombocytopenic Purpura?

• Acute thrombocytopenia
• Chronic ITP