Bay Biosciences provides high-quality biopsy tissue samples, formalin fixed paraffin embedded (FFPE) tissue blocks, with matched fresh frozen sera (serum), plasma, and peripheral blood mononuclear cells (PBMC) bio-fluids, from patients diagnosed with Immune thrombocytopenic purpura (ITP).
The sera (serum), plasma and PBMC biofluid specimens are processed from patient’s peripheral whole-blood using customized collection and processing protocols from Immune thrombocytopenic purpura (ITP).
Fresh frozen tissue and matched biofluid samples are collected from unique patients diagnosed with Immune thrombocytopenic purpura (ITP).
Bio-samples are provided to a valued pharmaceutical customer for research, diagnostics, discovery and drug development.
Immune Thrombocytopenic Purpura (ITP) Overview
Idiopathic thrombocytopenic purpura is an rare autoimmune disorder in which a person’s blood doesn’t clot normally, because the immune system destroys the blood-clotting platelets. This condition is more commonly known as immune thrombocytopenia (ITP).
“Thrombocytes” are the platelets, and “penia” means you don’t have enough of something.
ITP can cause excessive bruising and bleeding. An unusually low level of platelets, or thrombocytes, in the blood results in ITP.
Platelets are produced in the bone marrow. They help stop bleeding by clumping together to form a clot that seals cuts or small tears in blood vessel walls and tissues. If your blood doesn’t have enough platelets, it’s slow to clot. Internal bleeding or bleeding on or under the skin can result.
A healthy person usually has a platelet count of 150,000 and 450,000/mm. Platelet counts below 50,000 mm increase the risk of dangerous bleeding from trauma; counts below 20,000/mm increase the risk of spontaneous bleeding. You have thrombocytopenia if your number falls under 150,000.
Patients with immune thrombocytopenia (ITP) often have many purple bruises called purpura on the skin or mucous membranes inside the mouth. These bruises may also appear as pinpoint-sized red or purple dots on the skin called petechiae. Petechiae often look like a rash.
ITP can occur in both children and adults. There appears to be differences at certain ages between women and men and the development of ITP. At younger ages, ITP may be more common in women.
At older ages, it may be more common in men. Children are most likely to develop this condition after a general viral illness. Some specific viruses, such as chickenpox, mumps, and measles, have been linked to ITP as well.
According to the national organization of rare diseases (NORD) the prevalence (how many people are diagnosed each year) of immune thrombocytopenia (ITP) among adults in the Unites States is estimated to be 3.3 per 100,000 adults/year.
Types of Immune Thrombocytopenia (ITP)
The two main types of immune thrombocytopenia (ITP) are acute (short term) and chronic (long term).
Acute ITP is the most common form of the disorder in children. It usually lasts less than six months.
Chronic ITP lasts six months or longer. It’s most commonly seen in adults, although teenagers and younger children can also be affected.
Causes of Immune Thrombocytopenia (ITP)
Exact cause of immune thrombocytopenia (ITP) is not known, but it is thought that some kinds of viral infection may cause the immune system to malfunction and start producing antibodies that attack platelets.
In ITP, the immune system produces antibodies against platelets. These platelets are marked for destruction and removal by the spleen, which lowers the platelet count. The immune system also appears to interfere with cells responsible for normal platelet production, which can further lower the number of platelets in the blood stream.
In children, ITP often develops acutely following a virus. In adults, ITP usually develops over time.
ITP can also be classified as primary, occurring on its own, or secondary, occurring alongside another condition. Autoimmune diseases, chronic infections, medications, pregnancy, and certain cancers are common secondary triggers.
Secondary immune thrombocytopenia (ITP) happens when ITP is linked to another condition, such as:
- Viral infections (including chickenpox, parvovirus, hepatitis C, Epstein-Barr, and HIV)
- Systemic Lupus Erythematosus (SLE)
- Chronic lymphocytic leukemia (CLL)
- Drug-induced immune thrombocytopenia
- Sepsis a severe bacterial infection in your blood
- Helicobacter pylori (H. pylori), a bacteria that can live in your digestive system
Medicines Linked to ITP
Some medicines can increase the risk of ITP, such as:
- Certain drugs for heart problems, seizures, and infections
- Heparin, a blood thinner used to prevent blood clots
Your doctor will figure out if a drug is causing your platelet count to drop. They may be able to adjust your dose or change your medication.
Other Treatments Linked to ITP
- Heart bypass surgery
- Radiation treatment on your bone marrow
Signs and Symptoms of Immune Thrombocytopenia (ITP)
In most patients with mild immune thrombocytopenia (ITP), there are no symptoms and they will feel perfectly well. However, if the platelet count drops very low, they may experience an increase in bruising or bleeding.
Following are the common signs and symptoms of immune thrombocytopenia (ITP):
- Anxiety
- Anemia
- A skin rash of small red dots (petechiae), which does not blanch (go pale) with pressure
- Bleeding from the gums
- Blotches and bruises
- Depression
- Excessive bleeding during surgery
- Fatigue
- Frequent nosebleeds that take a long time to stop
- Internal bleeding
- Long or heavy menstrual periods
- Profuse bleeding during surgery
- Sudden leaking from tiny blood vessels
- Bleeding from any area of the body
- Skin that bruises very easily
- Stress
Diagnosis of Immune Thrombocytopenia (ITP)
Most of the time immune thrombocytopenia (ITP) has no symptoms and may be discovered during blood tests for an unrelated medical procedure. ITP is diagnosis of exclusion, once a low platelet count has been discovered, more tests are used to rule out any other causes.
Your doctor will perform a complete physical exam. They’ll ask you about your medical history and the medications you’re taking.
Following are the common tests used to diagnose immune thrombocytopenia (ITP):
- CBC Blood Tests: Complete blood count test will be performed to check for platelet numbers, to see if there are abnormalities in other blood counts, also to check if the blood cells look normal under the microscope.The blood tests may also include tests to evaluate your liver and kidney function, depending on your symptoms. A follow-up blood test that checks for platelet antibodies may also be recommended.
- Bone Marrow Biopsy: If you have a low platelet count, your doctor may also order a bone marrow test. Doctors remove a small sample of bone marrow through a needle and then check it in a laboratory. In a patient with ITP, the platelets produced in the bone marrow should be normal. This is because your platelets are destroyed in the bloodstream and spleen after they leave the bone marrow. If your bone marrow is abnormal, your low platelet count will likely be caused by another disease, rather than ITP.
- Blood Smear: This shows how your platelets look under a microscope.
- Other Tests: To rule out other conditions that may cause a low platelet count, such as acute leukemia and aplastic anemia.
Treatment of Immune Thrombocytopenia (ITP)
Treatment of immune thrombocytopenia (ITP) based on the total number of platelets you have and on how often and how much you bleed. In some cases, ITP goes away by itself. In cases where the platelet count is very low or there is evidence of bleeding, some form of treatment will be started.
Platelets counts that become too low put you at risk for spontaneous bleeding in the brain and other organs. Low red blood cell counts can also be a sign of internal bleeding.
First-line treatments (the preferred treatments, or the ones that are tried first) for ITP include:
- Corticosteroids: These medications are used to reduce the activity of the immune system. They may be given as intravenous injections or tablets
Dexamethasone or prednisone is typically prescribed to raise the patients platelet count. It can be taken once a day in the form of a pill or tablet. An increased or normalized platelet count is generally seen within 2 weeks of therapy, particularly with high-dose dexamethasone.
There are some side effects to prednisone, especially if you use it for a long time. Even after a short time, you can get irritable, have stomach upsets, and have other problems such as:
- Acne
- Frequent urination
- Sleep problems
- Puffy cheeks
- Lower bone density
- Weight gain
Besides side effects, another disadvantage to prednisone is that your platelet count may drop again once the treatment is finished.
- Intravenous immunoglobulin (IVIG): This is a blood product that consists of concentrated antibodies. It is thought that the autoantibodies might be ‘swamped’ by IVIG, reducing their ability to target platelets. IVIG has to be given by an intravenous infusion and may take a couple of hours.
Second-line treatments (those used if the first-line treatments do not work) include:
- Splenectomy: Surgical removal of the spleen. This operation cures ITP in about 70 per cent of chronic cases
- Thrombopoietin analogues: Treatment to increase production of new platelets in the bone marrow
- Monoclonal antibodies to CD20, an injection treatment targeting antibody-producing cells.
Occasionally, a patient who appears to have been cured of immune thrombocytopenia (ITP) will experience a relapse, perhaps months or even years after the initial episode. If this happens the patient will need repeat treatment. In most cases, the relapse seems to be triggered by a viral infection.
Complications of Immune Thrombocytopenia (ITP)
The most dangerous complication of ITP is bleeding, especially bleeding into the brain, which can be fatal. However, serious bleeding is rare.
The treatments for ITP can have more risks than the disease itself. The long-term use of corticosteroids can cause serious side effects, including:
Surgery to remove the spleen permanently increases your risk of bacterial infections and the risk of becoming seriously ill if you get an infection. It’s important to watch for any symptoms of infection and report them to your doctor promptly.
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