Thrombocytopenic Purpura

What is Thrombocytopenic Purpura?

Thrombocytopenia is a type of blood disorder where the body’s platelets, or cells that help blood clot and prevent excessive bleeding, drop well below normal levels. This can then lead to easy or excessive bleeding, as well as bruising.  There are two basic types of Thrombocytopenic Purpura; Immune (ITP) and Thrombotic. We will focus on ITP, which may also be referred to as idiopathic thrombocytopenia. ITP affects both children and adults.  Although children typically develop ITP through exposure to a viral infection, they generally recover fully without treatments, while adults affected by ITP generally suffer from the disorder for longer terms and require additional treatment. The normal platelet count is between 150,000 and 450,000 platelets per microliter of blood.  When the number of platelets falls below 150,000, there is potential for internal bleeding which can lead to potentially life-threatening scenarios. Individuals with a platelet level below 150,000 may have ITP and should seek medical evaluation as soon as possible.

What causes Thrombocytopenic Purpura?

Thrombocytopenic Purpura is generally caused by the immune system mistakenly attacking and destroying blood platelets in the body of an affected individual. However when the cause of the immune reaction is unknown, the condition is referred to by the older name, Idiopathic Thrombocytopenic Purpura, because Idiopathic means “of unknown cause”. Thrombocytopenic Purpura can develop as a result of family history, though there are a number of other potential causes that can lead to the decline in platelets. These include:

  • Viral infections
  • Systemic lupus erythematosus
  • Chronic lymphocytic leukemia
  • Drug-induced immune thrombocytopenia
  • Sepsis as a result of a bacterial infection in the blood of the affected
  • Helicobacter pylori, a bacteria commonly found in the digestive system
  • Medication used for heart problems, seizures, or infections
  • Heparin, a blood thinner
  • Chemotherapy

In the case of children with ITP, there is a very good chance that the disorder developed as a result of a viral illness like the mumps, the flu, or even chicken pox. In these instances, it is usually the infection itself that triggers the immune system malfunction. Additionally, women have been found to be twice as likely to develop ITP as men.

What are the symptoms of Thrombocytopenia?

The presence and severity of signs and symptoms often depend on platelet levels.  As such, some people with Thrombocytopenia have no real symptoms, though, when symptoms are present they may include the following:

Bleeding: Generally, through the gums, nose, or for women this may mean heavier or longer periods or breakthrough bleeding. Individuals affected by Thrombocytopenic Purpura may also see blood in their urine or feces.

Red Spots on Skin: You may see an outbreak of red, flat, spots on your skin. These are typically about the size of a pinhead, and usually, appear on an individual’s legs or feet, and may appear in clumps or clusters. These red spots are known as petechiae and occur as a result of bleeding occurring just under the skin.

Blotches & Bruises: Another sign of Thrombocytopenic Purpura may be outbreaks in blotches and bruises. These may present as blue, purple, or change from yellow to green over time. You may see these large areas of bleeding, and when pressed, they do not turn white like typical bruises. These blotches are as a result of sudden leaking from tiny blood vessels under the skin. This is known as purpura.

How is Thrombocytopenia diagnosed?

The most common way to diagnose Thrombocytopenia is through routine blood tests to identify the number of platelets in the body. As Thrombocytopenia occurs when the number of platelets drops below 150,000, this is a sure fire sign as to its presence in the body. A doctor may also perform a physical examination to check for signs of bleeding, as well as to identify if your spleen is enlarged. Methods for checking for low platelet levels include: 

CBC (Complete Blood Count): This is a test to measure the total amount of red and white blood cells and platelets

Blood Smear: During this test, a doctor reviews how your platelets look under a microscope.

Bone Marrow Test: This test involves a very fine needle to draw a sample of liquid bone marrow from the body to then check for cells that may not be working as they should. This may then lead to a biopsy with a different type of needle so that the doctor can check the number and types of cells within the bone marrow.

To help identify if ITP is the cause of the issues experienced by an individual, a doctor may also ask a series of questions to help identify a potential source of the issue. These may include the following:

  • What symptoms, including bleeding, have been present?
  • When did they first occur?
  • What medications or supplements are you taking? Have these helped make anything better? Worse?
  • Have you had any shots, transfusions, or taken intravenous narcotics within the last month?
  • Is there any family history of immune system problems, bleeding, or bruising?
  • What have you recently eaten?

How is Thrombocytopenic Purpura treated?

Although it may be difficult to diagnose the cause of Thrombocytopenic Purpura, fortunately there are a variety of available treatment options. This can even include just regular monitoring and platelet checks. Children typically do not need treatment, while most adults with Thrombocytopenic Purpura will eventually need some sort of treatment if the condition becomes severe or is present for a long time. If this is the case, there are several suggested treatment methodologies, including platelet transfusions and splenectomy (surgery to remove the spleen). Some individuals have found, however, that the surgical treatment of the disorder can be more burdensome that the actual effects of the disorder itself. However, at the end of the day, all treatment methods are designed to simply increase the platelet count. This may be accomplished through medication, as well as lifestyle changes.

Common Medications for Thrombocytopenic Purpura

Before prescribing any particular medication or supplement, a doctor will first review what you are currently taking to identify if there is any specific medication that may be leading to a decline in platelet count. Common examples of this include aspirin, ibuprofen, ginkgo biloba, and warfarin. From that point, a doctor may prescribe one of the following types of medication, aimed at treating Thrombocytopenic Purpura:

  • Drugs to Suppress the Immune System: This may include an oral corticosteroid, such as prednisone. Ideally this drug will help lead to an increase in the platelet count by decreasing overall activity within your immune system. Once the platelet count has returned to a safe level, a doctor will have you gradually discontinue this treatment, which typically takes between two and six weeks.
  • Injections to increase blood count: If drugs to suppress the immune system don’t help, then your doctor may recommend an injection of immune globulin (IVIG). This may be used if there is critical bleeding or if there is a need to rapidly increase the platelet count in the body before an individual undergoes surgery.
  • Drugs that boost platelet production: There are a handful of different drugs that are designed to boost the production of platelets in bone marrow. These include romiplostim and eltrombopag, amongst others. The unfortunate side effects of these drugs include headaches, dizziness, nausea, vomiting, and increased risk of developing blood clots.

Thrombocytopenic Purpura compensation

With all vaccines it is important to keep in mind that although vaccines may carry some risk of side effects, including ITP, vaccines prevent many more cases of diseases than they cause. In particular, ITP has only been associated with vaccines carrying the attenuated Measles virus and very rarely at that. This is a reason why ITP is listed as a table injury in the National Vaccine Injury Compensation Program (“VICP”) only for vaccines against Measles. Research has shown that the vaccine may result in 1 to 3 children developing ITP for every 100,000 vaccine doses administered. If this is the case, it may take up to 6 weeks for a child to display symptoms of ITP after vaccine administration. If ITP develops after the receipt of a non-Measles vaccine a claim may still be filed with the VICP, provided that the vaccine in question is covered under the program and certain other criteria are met. If you believe you or your child may have developed ITP as a result of a vaccine against the Measles virus or another vaccine covered under the VICP, contact one of our  vaccine injury attorneys today.

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