BLOOD The Blood is the most vital fluid; it is the fluid of life.

The blood provides communication between the external and internal environments. It affects all the cells, tissue, organs and organs systems of the body. Therefore, hematologic disorders profoundly affect the entire body, resulting in tissue hypoxia, infection or hemorrhage. BLOOD IS MADE OF A liquid component PLASMA carries antibodies and nutrients to tissues and carries waste away. Consists mainly of the proteins, albumin, globulin, and fibrinogen held in aqueous suspension. Other components in plasma include glucose , lipids, amino acids, electrolytes, pigments, hormones, oxygen and carbon dioxide. These components regulate acid-base balance and immune responses as well as carry nutrients to tissues and help to mediate coagulation. Important products of metabolism that circulate in plasma include urea, uric acid, creatinine, and lactic acid.

Cellular components ERYTHROCYTES (RED BLOOD CELLS) carry oxygen to the tissues and remove carbon dioxide from them.

LEUKOCYTES (WHITE BLOOD CELLS) participate in the inflammatory and immune response. 1. GRANULOCYTES(1st line of cellular defense against foreign organism) NEUTROPHILS are phagocytic; they engulf, ingest and digest foreign materials. EOSINOPHILS participate in allergic responses. BASOPHILS secrete histamine response to certain inflammatory and immune stimuli. They also secrete heparin which prevents abnormal clotting in the blood vessels.

2. AGRANULOCYTES

- MONOCYTES enlarge and mature to become macrophage or histiocytes; they perform phagocytosis. - LYMPHOCYTES (T- lymphocytes and B-lymphocytes) are responsible for specific immune responses. T-cells are involved in cell-mediated immunity, while B-cells are involved in humoral immunity. THROMBOCYTES (PLATELETS) along with the coagulation factors in plasma, are essential to normal blood clotting. LEUKEMIA
Are cancers of the blood-forming tissues. White blood cells may be produced in excessive amounts and are unable to work properly which weakens the immune system.

They help constrict damaged blood vessels. They form hemostatic plugs in injuryed blood vessels by becoming swollen, spiky, sticky, and secretory. They provide substances that accelerate blood clotting such as factors III and XIII and platelets factor 3.

Normally, blood cells are produced in an orderly, controlled way, as the body needs them. This process helps keep us healthy. When leukemia develops, the body produces large numbers of abnormal blood cells. In most types of leukemia, the abnormal cells are white blood cells. The leukemia cells usually look different from normal blood cells, and they do not function properly.

POSSIBLE RISK FACTORS

ionizing radiation exposure to chemicals and drugs bone marrow hypoplasia (reduced production of blood cells) genetic factors immunologic factors Environmental factors and the interaction of theses factors.

PATHOPHYSIOLOGY

PHYSICAL MANISFESTATION
Integumantary Manifestations: Ecchymoses Petechiae Open infected lesions Pallor of the conjunctiva, nail beds, palmar creases, and around the mouth. Gastrointestinal Manifestations: Bleeding gums Anorexia Weight loss Enlarged liver and spleen Renal Manifestations: Hematuria Cardiovascular Manifestations: Tachycardia at basal activity levels. Orthostatic hypotension Palpitations Respiratory Manifestations: Dyspnea on exertion. Neurologic Manifestations: Fatigue Headache Fever Musculoskeletal Manifestations: Bone pain Joint swelling and pain. Diagnostic Evaluation 1. CBC and blood smear peripheral WBC count varies widely from 1,000 to 100,000/mm3 and may include significant numbers of abnormal immature (blast) cells, anemia may be profound; platelet count may be abnormal and coagulopathies may exist. 2. Bone marrow aspiration and biopsy cells also studied for chromosomal abnormalities (cytogenetics) and immunologic markers to classify type of leukemia further. 3. Lymph node biopsy to detect the spread. 4. Lumbar puncture and examination of cerebrospinal fluid for leukemic cells (especially ALL). Treatment To eradicate leukemic cells and allow restoration of normal hematopoiesis.

1. High-dose chemotherapy given as an induction course to obtain a remission (disappearance of abnormal cells in bone marrow and blood) and then in cycles as consolidation or maintenance therapy to prevent recurrence of disease. 2. Leukapheresis (or exchange transfusion to infants) may be used when abnormally high numbers of white cells are present to reduce the risk of leukostasis and tumor burden before chemotherapy. 3. Radiation particularly of central nervous system (CNS) in ALL. 4. Autologous or allogeneic bone marrow or stem cell transplantation. Complications 1. Leukostasis; in setting of high numbers (greater than 50,000/mm3) of circulating leukemic cells (blasts), blood vessel walls are infiltrated and weakened, with high risk of rupture and bleeding, including intracranial hemorrhage. 2. Disseminated intravascular coagulation(DIC). 3. Tumor lysis syndrome: rapid destruction of large numbers of malignant cells leads to alteration in electrolytes (hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia). 4. May lead to renal failure and other complications. 5. Infection, bleeding, and organ damage. Pharmacologic Interventions

Acute leukemia Different types of leukemia are best treated with different kinds of medicine.
Acute lymphoblastic leukemia (ALL) drugs include prednisone, vincristine, daunorubicin, Lasparaginase or pegaspargase, methotrexate, and cyclophosphamide. Imatinib (Gleevec) is sometimes used to treat ALL. Dasatinib (Sprycel) is a newer drug for treating some ALL that has not improved with other drugs. Acute myelogenous leukemia (AML) drugs include daunorubicin, idarubicin, cytosine arabinoside, and mitoxantrone.10 Gemtuzumab (Mylotarg) may be given to people whose AML has relapsed. It helps your body destroy cancer cells. Acute promyelocytic leukemia (APL) drugs include all-trans-retinoic acid (ATRA) and chemotherapy with arsenic trioxide, idarubicin, or daunorubicin. ATRA helps control the risk of life-threatening bleeding from disseminated intravascular coagulation (DIC). Later treatment can include ATRA with or without methotrexate and 6-mercaptopurine. Or if a first round of ATRA and chemotherapy does not work, arsenic trioxide may be used.10 To treat leukemia in the brain or prevent it from spreading to the brain and central nervous system, methotrexate and cytarabine/cytosine arabinoside are injected into the spinal canal. This is called intrathecal chemotherapy.

Supportive treatments during cancer treatment include:

Antibiotics and immunoglobulins help to prevent or fight infections. This is important when you do not have enough normal white blood cells to fight infections on your own. Transfusions of red blood cells and platelets.

Epoetin and hematopoietic stimulants help your body make new blood cells. Allopurinol to prevent kidney problems and gout. Saline or steroid eyedrops for relief during treatment with cytarabine/cytosine arabinoside.

Chronic leukemia
Chemotherapy for chronic leukemia can involve a single drug or a combination of drugs. For example, you may be given a combination of cyclophosphamide, vincristine, and prednisone. Other drug choices include fludarabine, chlorambucil, hydroxyurea (hydroxycarbamide),cytarabine, busulfan, rituximab, and alemtuzumab. Allopurinol may be given to prevent kidney problems and gout. Dasatinib (Sprycel) blocks the growth of cancer cells. It can be used for CML that has not been helped by imatinib or other drugs. Imatinib (Gleevec) blocks the growth of cancer cells. It is often given to people who havechronic myelogenous leukemia (CML). Immune globulin (IG) helps prevent infections. It is sometimes used for people with chronic lymphocytic leukemia (CLL), because CLL weakens the immune system. Interferon alfa helps your immune system fight disease and may keep cancer cells from growing. It is often given to people who have CML.

Medication for nausea and vomiting Nausea and vomiting are common side effects of chemotherapy. These side effects usually are temporary and go away when treatment is stopped. Your doctor will prescribe drugs to help relieve nausea. These may include:
Aprepitant (Emend), which is used in combination with ondansetron and dexamethasone as part of a 3-day program. Dimenhydrinate, such as Dramamine. Metoclopramide, such as Reglan and Octamide. Phenothiazines, such as Compazine and Phenergan. Serotonin antagonists, such as ondansetron (Zofran), granisetron (Kytril), or dolasetron (Anzemet). These drugs work best when they are combined with corticosteroids such as dexamethasone (Hexadrol). Nursing Interventions Preventing infection: Frequently monitor the client for pneumonia, pharyngitis, esophagitis, perianal cellulitis, urinary tract infection, and cellulitis, which are common in leukemia and which carry significant morbidity and mortality. Monitor for fever, flushed appearance, chills, tachycardia; appearance of white patches in the mouth; redness, swelling, heat or pain in the eyes, ears, throat, skin, joints, abdomen, rectal and perineal areas; cough, changes in sputum; skin rash. Check results of granulocyte counts. Concentrations less than 500/mm3 put the patient at serious risk for infection.

Avoid invasive procedures and trauma to skin or mucous membrane to prevent entry of microorganisms. Use the following rectal precautions to prevent infections: Avoid diarrhea and constipation, which can irritate the rectal mucosa, avoid the use of rectal thermometers, and keep perineal are clean. Care for the patient in private room with strict handwashing practice. Encourage and assist patient with personal hygiene, bathing, and oral care. Obtain cultures and administer antimicrobials promptly as directed. Preventing and Managing bleeding: Watch for signs of minor bleeding, such as petechiae, ecchymosis, conjunctival hemorrhage, epistaxis, bleeding gums, bleeding at puncture sites, vaginal spotting, heavy menses. Be alert for signs of serious bleeding, such as headache with change in responsiveness, blurred vision, hemoptysis, hematemesis, melena, hypotension, tachycardia, dizziness. Test all urine, stool, emesis for gross and occult blood. Monitor platelet counts daily. Administer blood components as directed. Keep patient on bed rest during bleeding episodes. Patient Education and Health Maintenance: Teach signs and symptoms of infection and advise whom to notify. Encourage adequate nutrition to prevent emaciation from chemotherapy. Teach avoidance of constipation with increased fluid and fiber, and good perineal care. Teach bleeding precautions. Encourage regular dental visits to detect and treat dental infections and disease.

Classifications of Anemia
Posted by: Daisy Jane, RN October 21, 2010 Comments (0) Email This Post Print This Post Overview The main function of a red blood cell or erythrocyte is to carry and transport oxygen to the different parts of the body. The normal RBC count is 4-6 million/mm3. Hemoglobin (Hgb), an ironbearing protein, is found inside an erythrocyte. Molecules of this iron containing protein are responsible for transporting the bulk of oxygen that is carried in the blood. The more hemoglobin molecules the RBC contain, a higher amount of oxygen will they be able to carry. If the hemoglobin is defective, the erythrocyte will also malfunction. A red blood cell is just a vessel; the one that performs the oxygen transportation is the hemoglobin. Normal hemoglobin is 1318 grams/dl in males and 12-16 grams/dl in females. A decrease in the RBC or hemoglobin or the oxygen-carrying ability of a blood is termed as anemia. Erythrocyte Formation

RBCs are produced by the bone marrow a process known as erythropoiesis. Before a red blood cell is formed, the hematopoietic stem cell first produces an uncommitted stem cell to be formed to committed progenitor cell. Progenitor cells are not only the precursor of RBC, but also of lymphocytes and megakaryocytes (antecedent of platelets). Before an erythrocyte is formed the progenitor cells develop an erythroblast, then a reticulocyte, and finally erythrocyte (RBC). A hormone, erythropoietin, which is secreted by the kidney, also controls RBC production by stimulating the bone marrow. Types of anemia Hypoproliferative Anemias This type of anemia covers all condition where the bone marrow incapable of producing enough cells to develop to erythrocyte. Lack of erythropoietin may also be a contributing factor of the abnormality. The following types of anemia are under this classification: Aplastic anemia In this condition, the precursor cells (stem or progenital cells, which is responsible in forming components of blood) are extremely deficient, thereby, production of all formed elements (including RBC, lymphocyte, megakaryocytes) are reduced. Because of the depressed bone marrow function, it is replaced by fat cells leading to anemia, excessive bleeding (thrombocytopenia) and infections (depressed WBC count). This type of anemia is also a common example of a pancytopenic disorder. Iron-deficiency anemia It is also called microcytic, hypochromic anemia. This is type of anemia is the most common form among all ages, and is characterized by a low iron concentration in the body. Megaloblastic anemia A macrocytic, normochromic anemia results as the essential factors (vitamin B12 and folic acid) for normal DNA synthesis are missing causing suppression of mitosis in the bone marrow and allowing the RNA or protein synthesis to take place for the progression of cell growth without cell division. The resulting cells remain enlarged (because mitosis is absent). 1. 1. Vitamin B12 deficiency Vitamin B12 or cobalamin is required for normal DNA synthesis. It is not synthesized in the tissues of but solely depends on the dietary intake of meat, liver, dairy products and sea foods. 2. 2. Folic Acid Deficiency folic acid is also important for the DNA synthesis of cells. The dietary sources of folate are meats, eggs, leafy vegetables which are easily available. Hemolytic Anemias This type of anemia refers to the state where hemolysis (erythrocyte destruction) causes symptoms of anemia. Classification of this condition is further narrowed into intrinsic (inherited) or extrinsic (damage in erythrocyte is caused by environmental factors). Intrinsic Hemolytic Anemia 1. Sickle Cell anemia an inherited disorder on the beta chain of the hemoglobin resulting to abnormally shaped red blood cells. In this condition an abnormal hemoglobin S (HbS) is contained in the RBCs causing distortions or sickling of the red blood cells. 2. Thalassemia group of genetic disorders that involve a defective hemoglobin- chain synthesis. Thalassemia major is threatening disease characterized by severe anemia,

hemolysis and ineffective erythropoiesis. Thalassemia minor is a mild form of anemia. The affected individual has only one defective gene and is asymptomatic. Extrinsic Hemolytic Anemia 1. Immune hemolytic anemia a persons own antibodies destroy his own red blood cells (hemolysis). 2. Mechanical hemolytic anemia hemolysis is caused by trauma or physical injuries that disrupt red blood cells altering and tearing them through the small vessels. Erythrocyte Disorders If the number of erythrocytes is excessive or inadequate, erythrocytes problems would arise. Excessive numbers of erythrocytes result to a condition called polycythemia. When erythrocytes numbers is decreased or hemoglobin levels drop, the condition of compromised oxygen transport occurs resulting to anemia. Anemia Whatever the reason is, when a decrease in the oxygen-carrying capacity of the blood takes place the resulting condition is anemia. This is usually indicated by a hemoglobin levels that falls below the lower limit of its normal range (listed above). Anemia may be the result of the following: 1. Decreased number of Red Blood Cells 2. Abnormal or deficient Hemoglobin content in the RBCs As a result, a decline in the bloods oxygen transport capacity would trigger the various physiologic compensations. The following physiologic compensatory events follow when hemoglobin or red blood cells levels drop: 1. Arteriolar dilatation to provide increased blood flow. 2. Increased blood flow would result to an elevation of cardiac output. 3. Shift to anaerobic metabolism to reduce oxygen compensation and indirectly promote the dissociation of oxygen from hemoglobin. 4. Increased renal secretion of erythropoietin to stimulate the marrow to increase erythropoiesisand speed RBC production. Inability of the body to facilitate the listed compensatory mechanisms would result to a drop in hemoglobin levels to 7-8 g/dl. Thus, signs and symptoms of hypoxia emerge such as the following: 1. Paleness or pallor 2. Weakness 3. Lethargy 4. Excessive intolerance Polycythemia Increased red blood cell concentration in the blood leads to a condition cally polycythemia. Polycythemia may be due to: 1. An increase in red cell numbers with a normal plasma volume 2. Absolute polycythemia

3. Normal red blood cell numbers suspended in a reduced plasma volume a condition called relative polycythemia These conditions would result to an elevated packed cell volume (PCV), hematocrit and the hemoglobin level. Absolute Polycythemia versus Secondary Polycythemia In primary absolute polycythemia, an overproduction of erythrocytes by the marrow takes place. Secondary polycythemia occurs when the renal output of eryhthropoiesis is elevated hence, resulting to an increased activity of the marrow. The latter condition is a result of physiologic compensatory mechanism of the tissue to hypoxia. In cases where erythropoietin (EPO) production is increased but no physiologic requirement is present, possible renal tumor is present. Aside from that, smokers may also suffer from secondary polycythemia. Significant levels of carbon monoxide are delivered to the blood when products of combustion are inhaled. Carbon monoxide binds with hemoglobin 200 times than that of oxygen. Thus, presence of this chemical in a smokers blood would result to a compromised oxygen delivery and increased erythropoietin secretion in the renal system. In primary absolute polycythemia, there is no elevated erythropoietin stimulus even when the marrow stem cells are proliferating. This condition is an effect of the presence of a benign tumor. The red cells are proliferating resulting to a dominant amount of eryhthrocytes in the blood over other components. In such cases, the normal or elevated tissue supply of oxygen suppresses EPO secretion. Polycythemia Vera Sometimes called polycythemia rubra vera, polycythemia vera is another myeloproliferative condition which is characterized by an increased viscosity of the blood. The thickened blood sluggishly flows through the small vessels. Coagulation within these vessels is predisposed by this event especially in the kidneys, spleen and liver. Blockage of the vessels results to nutrient deprivation and tissue destruction. Relative Polycythemia With relative polycythemia, hematocrit levels are increased (information about hematocrit discussed below), however, the total number of red blood cells is just normal. The plasma deficiency that produces this state may be the result of the following conditions: Generalized dehydration Extensive skin burns Pronounced diarrhea or vomiting Diuresis Heavy smoking smokers polycythemia. Stress stress polycythemia. Typically, hard-driving male sufferers are also at high risk for heart and brain vascular diseases. Points to Remember The major problem in cases of polycythemia or excessive red blood cells is the increased viscosity of the blood, which causes it to flow sluggishly in the body and worst impairing the circulation.

The major problem in cases of anemia or decreased red blood cell count or hemoglobin levels is the decreased in blood viscosity, which results to thinning of the blood and its flowing rapidly into the vessels.

Megaloblastic Anemias
Posted by: Daisy Jane, RN January 14, 2011 Comments (0) Email This Post Print This Post

Definition Megalosblastic anemias are characterized by the presence of enlarged red cells (megaloblasts) due to the impaired cell division. Because the erythrocytes that reach the circulation are enlarged, a macrocytic and normochromic anemia results. Pathophysiology Causes Vitamin B12 deficiency Folic acid deficiency Vitamin B12 and Folic acid are essential for normal DNA synthesis of erythrocyte formation. When these vitamins are deficient erythrocytes DNA synthesis is affected. Mitosis in the progenitor lines is suppressed and abnormal increase in the number of normal cells or hyperplasia occurs. Since there is no impairment of the RNA or protein synthesis cell growth still proceeds. However, because mitosis or cell division cant occur (because of the absence of Vitamin B12 and Folic Acid) the marrow precursors (erythroid and myeloid cells) remain enlarged which are termed asMEGALOBLASTS. Many of these cells die within the marrow so the mature cells that leave the marrow is decreased in number. As a result, pancytopenia (deficiency of all cellular elements of the blood) develops. Types of megaloblastic anemia Vitamin B12 deficiency Vitamin B12, also known as cobalamin, is not synthesized in the tissues. Thus, the body relies on the dietary intake of meat, liver, seafood and dairy products to supply our needs. The body stores more than a 3-year supply of vitamin B12 in the liver. Causes: 1. Inadequate dietary intake 2. Impaired gastrointestinal absorption (absence of intrinsic factor, pernicious anemia, gastrectomy, chronic gastritis)

Clinical Manifestations: 1. Weakness 2. Listless 3. Pale 4. Smooth sore red tongue and diarrhea (those with pernicious anemia) 5. Neurologic manifestations (confusion, paresthesia, paralysis, severe neuropathy) Diagnostic evaluation: Schilling test (to determine the cause of Vitamin B12 deficiency) Management: Vitamin B12 replacement Oral supplementation if the cause is inadequate cobalamin intake. In cases of defective absorption or absence of intrinsic factor, replacement is by intramuscular (IM) injection of Vitamin B12. Folic Acid Deficiency Folic Acid is another vitamin that is necessary for normal red blood cell production. It is stored in the body as folates. The dietary sources of folate are meats, eggs and leafy vegetables. Body stores of folic acid provide a five-month period of tolerance from proven deficient folic acid in the diet. Causes: 1. Inadequate folate in the diet 2. Alcoholism (alcohol increases folic acid requirements in the body) Clinical Manifestations: Symptoms of folic acid and Vitamin B12 deficiency are the same however, neurologic manifestations of Vitamin B12 deficiency do not occur when folic acid is deficient. Management: 1. Nutritious diet 2. Administration of 1 mg folic acid a day (oral) 3. For patients with malabsorption, folic acid is administered intramuscularly (IM)

Iron-deficiency Anemia
Posted by: Ira Hope, RN October 9, 2010 Comments (0) Email This Post Print This Post

Definition: Iron deficiency anemia (IDA)is an ailment when there is not enough hemoglobin produced by the body to meet its requirement. The benchmark for its diagnosis is marked by below-normal total body iron Etiology: It is caused by inadequate intake of iron-rich foods or inadequate absorption of iron. Some of the known could be due to: a.) chronic diarrhea b.) malabsorption syndromes c.) high cereal intake with low animal protein ingestion partial or complete gastrectomy Prevalence: It is more common in developing countries and tropical zones. According to the Food and Nutrition Research Institute (FNRI) as of 2003, in the Philippines iron deficiency anemia is common among children 6 months to one year old, pregnant and lactating women. Government efforts are still being implemented since it poses a public concern. Women between 15 45 years old are the ones being mostly affected. Pathophysiology: In IDA, when iron levels in the body decreases, transferrin which binds with and transport iron is also depleted. As a result, red blood cells (RBCs) the oxygen carrying component of the blood is likewise depleted leading to decreased levels of hemoglobin in the body. Physical Findings: Asymptomatic if in mild cases palpitations, dizziness and cold sensitivity brittleness of hair, nails and pallor dysphagia, stomatis, atrophic glossitis dyspnea and weakness Diagnosttic Examinations: Complete Blood count first test to check the levels of the parts of the blood (red blood cells, white blood cells, platelets) Reticulocyte count - The test shows whether your bone marrow is making red blood cells at the correct rate. Peripheral smear To check whether the red blood cells look (microcytic) smaller and (hypochromic) paler than normal Serum iron markedly decreased

Serum ferritin decreased *Ferritin a protein that binds with iron in the body making it easier to be transported. Medical Management: 1. Oral supplements of iron (Ferrous Sulphate) 2. Parenteral Iron for children with iron malabsorption or chronic hemoglobinuria 3. Transfusion indicated for severe anemia cases of severe infection, cardiac dysfunction Nursing Management: 1. Asses for fatigue, activity intolerance, and other sings of impaired tissue oxygenation 2. Promote an adequate intake of iron-rich foods (iron fortified formula and cereals, liver, egg yolk, and organ meats 3. Emphasize to family members or care givers proper administration of oral iron supplements. Give supplements in two or three divided doses in small amount of Vitamin C-containing liquid. (This enhances absorption) 4. Explain the potential adverse effects of iron which includes nausea and vomiting, diarrhea or constipation or black stools and tooth discoloration. 5. Instruct care givers to keep iron supplements out of reach of children since it is toxic when overdosed.

Idiopathic Thrombocytopenic Purpura

(Also Called 'ITP (Immune Thrombocytopenic Purpura)')

What is Idiopathic Thrombocytopenic Purpura?

Idiopathic thrombocytopenic purpura (ITP) is a bleeding condition in which the blood doesn't clot as it should. This is due to a low number of blood cell fragments called platelets (PLATE-lets). Platelets also are called thrombocytes. They're made in your bone marrow along with other kinds of blood cells. Platelets stick together (clot) to seal small cuts or breaks on blood vessel walls and stop bleeding. "Idiopathic" means that the cause of the condition isn't known. "Thrombocytopenic" means there's a lower than normal number of platelets in the blood. "Purpura" refers to purple bruises caused by bleeding under the skin.

Overview
People who have ITP often have purple bruises that appear on the skin or on the mucous membranes (for example, in the mouth). The bruises mean that bleeding has occurred in small blood vessels under the skin. A person who has ITP also may have bleeding that results in tiny red or purple dots on the skin. These pinpoint-sized dots are called petechiae. Petechiae may look like a rash.

petechiae (red/purple dots) and purpura (bruises) in the skin. Bleeding under the skin causes the purple, brown, and red color of the petechiae and purpura. People who have ITP also may have nosebleeds, bleeding from the gums when they have dental work done, or other bleeding that's hard to stop. Women who have ITP may have menstrual bleeding that's heavier than usual. More extensive bleeding can cause hematomas. A hematoma is a collection of clotted or partially clotted blood under the skin. It looks or feels like a lump. Bleeding in the brain as a result of ITP is very rare, but can be life threatening if it occurs. In most cases, an autoimmune response is believed to cause ITP. Normally your immune system helps your body fight off infections and diseases. But if you have ITP, your immune system attacks and destroys its own platelets. The reason why this happens isnt known. ITP can't be passed from one person to another.

Types of Idiopathic Thrombocytopenic Purpura

There are two types of ITP: acute (temporary or short-term) and chronic (long-lasting). Acute ITP generally lasts less than 6 months. It mainly occurs in children, both boys and girls, and is the most common type of ITP. Acute ITP often occurs after an infection caused by a virus. Chronic ITP is long-lasting (6 months or longer) and mostly affects adults. However, some teenagers and children can get this type of ITP. Chronic ITP affects women 2 to 3 times more often than men. Treatment depends on how severe the bleeding symptoms are and the platelet count. In mild cases, treatment may not be needed.

Outlook
For most children and adults, ITP isn't a serious or life-threatening condition. Acute ITP in children often goes away on its own within a few weeks or months and doesn't return. In 80 percent of children who have ITP, the platelet count returns to normal within 6 to 12 months. Treatment may not be needed.

A small number of children, about 5 percent, whose ITP doesn't go away on its own may need to have further medical or surgical treatment. Chronic ITP will vary with each individual and can last for many years. Even people who have severe forms of chronic ITP can live for decades. Most people who have chronic ITP are able at some point to stop treatment and keep a safe platelet count. Other names for Idiopathic Thrombocytopenic Purpura

Immune thrombocytopenic purpura Autoimmune thrombocytopenic purpura

What causes Idiopathic Thrombocytopenic Purpura?

In most cases, it's believed that an autoimmune response causes idiopathic thrombocytopenic purpura (ITP). Normally, the immune system makes antibodies (proteins) to fight off germs or other harmful things that enter the body. In ITP, however, the immune system attacks and destroys the body's platelets by mistake. Why this happens isn't known. Children who get acute (short-term) ITP often have had recent viral infections. It's possible that the infection somehow "triggers" or sets off the immune reaction that leads to ITP in these children. ITP in adults, on the other hand, doesn't seem to be linked to infections.

Who is at risk for Idiopathic Thrombocytopenic Purpura?

Both children and adults can develop idiopathic thrombocytopenic purpura (ITP). Children usually get the acute (short-term) type of ITP. Acute ITP often develops after an infection caused by a virus. Adults tend to get the chronic (long-lasting) type of ITP. Women are 2 to 3 times more likely than men to get chronic ITP. ITP is a fairly common blood disorder, with 50 to 150 new cases per every 1 million people each year; about half of these cases are children. However, the number of cases of ITP is rising because routine blood tests that can detect a low platelet count are being done more often. ITP can't be passed from one person to another.

What are the signs and symptoms of Idiopathic Thrombocytopenic Purpura?

Having a low platelet count doesnt cause symptoms. However, the bleeding that a low platelet count can cause may have the following signs and symptoms:

Pinpoint red spots on the skin that often are found in groups and may look like a rash. The spots, called petechiae, are due to bleeding under the skin. Bruising or purplish areas on the skin or mucous membranes (such as in the mouth) due to bleeding under the skin. The bruises may occur for no known reason. This type of bruising is called purpura. More extensive bleeding can cause hematomas. A hematoma is a collection of clotted or partially clotted blood under the skin. It looks or feels like a lump.

Nosebleeds or bleeding from the gums (for example, when dental work is done). Blood in the urine or stool (bowel movement). Any kind of bleeding that's hard to stop could be a sign of ITP. This includes menstrual bleeding in women thats heavier than usual. Bleeding in the brain is rare, and the symptoms of bleeding in the brain may vary in severity. A low number of platelets doesn't cause pain, fatigue (tiredness), problems concentrating, or any other symptoms.

How is Idiopathic Thrombocytopenic Purpura Diagnosed?

Your doctor will diagnose idiopathic thrombocytopenic purpura (ITP) based on your medical history, a physical exam, and test results. Your doctor will want to make sure that your low platelet count isn't due to another condition (such as an infection) or a side effect of medicines you're taking (such as chemotherapy medicines or aspirin).

Medical history
Your doctor may ask about:

Your signs and symptoms of bleeding and any other signs or symptoms you're having Whether you have illnesses that could lower your platelet count or cause bleeding Medicines or any other over-the-counter supplements or remedies you take that could cause bleeding or lower your platelet count

Physical exam
Your doctor will give you a physical exam and look for signs of bleeding and infection. For example, your doctor may look for pinpoint red spots on the skin and bruising or purplish areas on the skin or mucous membranes. These are signs of bleeding under the skin.

Diagnostic tests
You'll likely have blood tests to check your platelets. These tests usually include: A complete blood count. This test shows the numbers of different kinds of blood cells, including platelets, in a small sample of your blood. In ITP, the red and white blood cell counts are normal. A blood smear. During this test, some of your blood is put on a slide. A microscope is then used to look at your platelets and other blood cells. In ITP, the number of platelets is lower than normal. You also may have a blood test to check for the antibodies that attack platelets. If blood tests show that you have a low number of platelets, your doctor may recommend more tests to confirm a diagnosis of ITP. For example, bone marrow tests, may be used to see whether your bone marrow is making platelets.

Some people who have mild ITP have few or no signs of bleeding. These people may be diagnosed only after a blood test done for another reason shows that they have a low platelet count.

How is Idiopathic Thrombocytopenic Purpura treated?

Treatment for idiopathic thrombocytopenic purpura (ITP) is based on how much and how often youre bleeding and your platelet count. In some cases, treatment may not be needed. Medicines often are used as the first course of treatment. Treatments used for children and adults are similar. Adults with ITP who have very low platelet counts or problems with bleeding often are treated. Adults who have milder cases of ITP may not need any treatment, other than watching their symptoms and platelet counts. The acute (short-term) type of ITP that occurs in children often goes away within a few weeks or months. Children who have bleeding symptoms, other than merely bruising (purpura), usually are treated. Children who have milder cases of ITP may not need treatment other than monitoring and follow-up to make sure platelet counts return to normal.

Medicines
If adults or children who have ITP need treatment, medicines often are tried first. Corticosteroids, such as prednisone, are commonly used to treat ITP. These medicines, called steroids for short, help increase your platelet count by lowering the activity of your immune system. However, steroids have a number of side effects, and some people relapse (get worse) when treatment ends. The steroids used to treat ITP are different from illegal steroids taken by some athletes to enhance performance. Corticosteroids aren't habit-forming, even if you take them for many years. Some medicines used to help raise the platelet count are given through a needle inserted into a vein. These medicines include immune globulin and anti-Rh (D) immunoglobulin. Medicines also may be used along with a procedure to remove the spleen, called splenectomy. If steroids, immunoglobulins, or splenectomy dont help, two newer medicines eltrombopag and romiplostimcan be used to treat ITP.

Removal of the spleen (splenectomy)

If necessary, the spleen will be removed surgically. This organ is located in the upper left abdomen. The spleen is about the size of a golf ball in children and a baseball in adults.

The spleen makes antibodies (proteins) that help fight infection. In ITP, these antibodies destroy platelets. If ITP hasn't responded to steroids, removing the spleen will reduce the destruction of platelets. However, it also may make you more likely to get certain infections. Before you have the surgery, your doctor may give you vaccines to help prevent these infections. If your spleen is removed, your doctor will explain what steps you can take to help avoid infections and what symptoms to watch for.

Other Treatments
Platelet transfusions
Some people with ITP who have severe bleeding may need to have platelet transfusions and be hospitalized. Some people will need a platelet transfusion before having surgery. For a platelet transfusion, donor platelets from a blood bank are injected into the recipient's bloodstream. This increases the platelet count for a short time.

Treating infections
Some infections can briefly lower a person's platelet count. If a person who has ITP has an infection that can lower his or her platelet count, treating the infection may help increase the platelet count and reduce bleeding problems.

Stopping medicines
If a person who has ITP is taking medicine that can lower his or her platelet count or cause bleeding, stopping the medicine can sometimes help increase the platelet count or prevent bleeding. For example, aspirin and ibuprofen are common medicines that increase the chance of bleeding. If you have ITP, your doctor may suggest that you avoid these medicines. How can Idiopathic Thrombocytopenic Purpura be prevented? You can't prevent idiopathic thrombocytopenic purpura (ITP), but you can prevent its complications.

Talk to your doctor about which medicines you can take. Your doctor may advise you to avoid medicines such as aspirin or ibuprofen that can affect your platelets and increase your risk of bleeding. Protect yourself from injuries that can cause bruising or bleeding. Seek treatment right away if you develop any infections. Report any symptoms of infection, such as a fever, to your doctor. This is very important for people with ITP who have had their spleens removed.

Living with Idiopathic Thrombocytopenic Purpura

If you have idiopathic thrombocytopenic purpura (ITP), you can take steps to prevent complications. Lifestyle changes and ongoing care can help you manage the condition.

Lifestyle changes
If you have ITP, try to avoid injuries, especially head injuries, that can cause bleeding in the brain. For example, dont participate in contact sports such as boxing, football, or karate. Other sports, such as skiing or horseback riding, also put you at risk for injuries that can cause bleeding. Some safe activities are swimming, biking, and walking. Ask your doctor about physical activities that are safe for you. Take precautions such as regular use of seatbelts and wearing gloves when working with knives and other tools. If your child has ITP, ask his or her doctor whether you need to restrict your child's activities.

Ongoing care
Find a doctor, preferably a hematologist, who is familiar with treating people who have ITP. Hematologists are doctors who specialize in diagnosing and treating blood diseases and disorders. Discuss with your doctor how to manage ITP and when to seek medical care. Talk to your doctor before taking prescription and over-the-counter medicines and nutritional supplements. Some medicines and supplements can affect platelets and increase your chance of bleeding. Common examples are aspirin or ibuprofen. Tell your doctor about all of the over-the-counter medicines you take, including vitamins, supplements, and herbal remedies. These products may contain substances that increase your risk of bleeding. Watch for symptoms of infection, such as a fever, and report them to your doctor promptly. If you've had your spleen removed, you may be more likely to become ill from certain types of infection.

Idiopathic Thrombocytopenic Purpura in pregnancy

In women who are pregnant and have ITP, the ITP usually doesn't affect the baby. However, some babies born to mothers who have ITP are born with or develop low numbers of platelets soon after birth. Their platelet counts almost always return to normal without any treatment. Treatment can speed the recovery in the few babies whose platelet counts are very low. Treatment for ITP during pregnancy depends on a woman's platelet count. If treatment is needed, the doctor will take a close look at the possible effects of the treatment on the unborn baby. Women who have milder cases of ITP usually can go through pregnancy without treatment. Pregnant women who have very low platelet counts or a lot of bleeding are more likely to have serious heavy bleeding during delivery or afterward. To prevent serious bleeding, these women usually are treated.

Key Points
Idiopathic thrombocytopenic purpura (ITP) is a bleeding condition in which the blood doesn't clot as it should. This is due to a low number of blood cell fragments called platelets. Platelets stick together (clot) to seal small cuts or breaks on blood vessel walls and stop bleeding. There are two types of ITP. Acute ITP is a short-term illness that mainly affects children and often occurs after a viral infection. Most children get well quickly without any treatment. Adults who have ITP most often have chronic (long-lasting) ITP. Symptoms can vary a great deal, and some adults who have mild ITP don't need treatment. In most cases, an autoimmune response is believed to cause ITP. Normally your immune system helps your body fight off infections and diseases. But if you have ITP, your immune system attacks and destroys its own platelets. The reason why this happens isn't known. ITP can't be passed from one person to another. ITP can affect children and adults of all ages. Women are 2 to 3 times more likely than men to get chronic ITP. People who have ITP may have signs of bleeding, such as bruises (purpura) that appear for no reason or tiny red dots (petechiae) that are visible on the skin. Bleeding in ITP also occurs in the form of nosebleeds, bleeding gums, menstrual bleeding thats heavier than usual, or other bleeding that's hard to stop. Bleeding in the brain as a result of ITP is very rare, but it can be life threatening when it occurs. ITP is diagnosed based on your medical history, a physical exam, and results from blood tests. Treatment for ITP is based on how much and how often youre bleeding and your platelet count. Medicines often are used as the first course of treatment. Treatments used for children and adults are similar. The spleen is sometimes removed if treatment with medicine fails to keep the platelet level high enough to prevent bleeding. You can't prevent ITP, but you can prevent its complications. Talk to your doctor about what medicines are safe for you, protect yourself from injuries that can cause bruising or bleeding, and seek treatment if any signs of infection develop. For most children and adults, ITP isn't a serious or life-threatening condition. Even people who have severe forms of chronic ITP can live for decade