Presentation on Presentation on

ITP ITP By James Runco By James Runco

““Everyone bleeds sometimes, Everyone bleeds sometimes,

I just bleed more.” I just bleed more.”

ITP ITP

ITP stands for ITP stands for

Idiopathic Thrombocytopenic PurpuraIdiopathic Thrombocytopenic Purpura

but it is also frequently called:but it is also frequently called:

Immune Thrombocytopenic Purpura orImmune Thrombocytopenic Purpura or

Idiopathic ThrombocytopeniaIdiopathic Thrombocytopenia

Background Information Background Information

There are three Basic types of blood cells There are three Basic types of blood cells made in the marrow of the bones each made in the marrow of the bones each with their own specialized jobs. with their own specialized jobs.

Red Blood Cells (Rbc’s) Carry OxygenRed Blood Cells (Rbc’s) Carry Oxygen

White Blood Cells (Wbc’s) Protect your body from infectionWhite Blood Cells (Wbc’s) Protect your body from infection

Platelets (Plt’s) Help your help your body to heal injuriesPlatelets (Plt’s) Help your help your body to heal injuries

This is a Picture of Normal Blood This is a Picture of Normal Blood CellsCells

What ITP does. What ITP does.

ITP is an autoimmune disease during which your ITP is an autoimmune disease during which your body’s immune system attacks and destroys body’s immune system attacks and destroys your platelets. your platelets.

The body releases auto-antibodies which The body releases auto-antibodies which chemically tag its’ own cells as foreignchemically tag its’ own cells as foreign

White blood cells then seek out and destroy White blood cells then seek out and destroy platelets as if they were fighting an infectionplatelets as if they were fighting an infection

This causes a rapid drop in the level of platelets in This causes a rapid drop in the level of platelets in a person’s body a person’s body

More about ITPMore about ITP

This Thrombocytopenia (lowered platelet level) is This Thrombocytopenia (lowered platelet level) is Idiopathic, (without known cause) and can be Idiopathic, (without known cause) and can be triggered at any time. triggered at any time.

Platelets are a specialized form of blood cells that Platelets are a specialized form of blood cells that are absolutely essential for your blood to clot. are absolutely essential for your blood to clot.

When they are attacked by the White Blood cells it When they are attacked by the White Blood cells it can be disastrous. can be disastrous.

Your body is left unable to mend any cuts or stop Your body is left unable to mend any cuts or stop bleeding even from the smallest internal injuries bleeding even from the smallest internal injuries

Symptoms of ITP Symptoms of ITP

Excessive bleeding with Excessive bleeding with minor injuriesminor injuries

Spontaneous bleeding from Spontaneous bleeding from the mouth and nosethe mouth and nose

Unexplainable or Unexplainable or spontaneous bruising spontaneous bruising

Excessive internal bleedingExcessive internal bleeding Disturbed sleep cycle/ Disturbed sleep cycle/

Insomnia Insomnia Irregular appetiteIrregular appetite DepressionDepression

Depression and ITPDepression and ITP

ITP is accompanied by short term or more ITP is accompanied by short term or more permanent depression. permanent depression.

This is because 2% of the body’s serotonin This is because 2% of the body’s serotonin is stored in the platelets; when the is stored in the platelets; when the platelets are destroyed so is this mood platelets are destroyed so is this mood elevating neurotransmitter. elevating neurotransmitter.

Platelets also carry Serotonin’s “parent” Platelets also carry Serotonin’s “parent” chemical called L-Tryptophanchemical called L-Tryptophan

Depression and ITP ContinuedDepression and ITP Continued

This L-Tryptophan is able to pass through This L-Tryptophan is able to pass through the blood brain barrier, so it’s loss is the the blood brain barrier, so it’s loss is the probable cause of the sleep/ eating probable cause of the sleep/ eating irregularities. irregularities.

This is JaneThis is Jane

Normal Platelet CountsNormal Platelet Counts

Thrombocytopenic Platelet CountsThrombocytopenic Platelet Counts

This is Jane with ITP This is Jane with ITP

CausesCauses

The exact causes of ITP are as yet unknown, but The exact causes of ITP are as yet unknown, but there is currently research going on to try and there is currently research going on to try and determine what causes this disease. determine what causes this disease.

There are many theories, most state that ITP is a There are many theories, most state that ITP is a multifactorial disease with a strong genetic multifactorial disease with a strong genetic predisposition. predisposition.

Researchers are currently looking for multiple Researchers are currently looking for multiple instances of ITP in a family, and have found that instances of ITP in a family, and have found that in some cases ITP can be passed from mother in some cases ITP can be passed from mother to child. to child.

Moms and ITP Moms and ITP

There seems to be a There seems to be a connection between ITP connection between ITP and pregnancy. A and pregnancy. A previously normal woman previously normal woman can sometimes develop can sometimes develop ITP during a pregnancy. ITP during a pregnancy.

Pregnancies are much more Pregnancies are much more dangerous for women dangerous for women with ITP, both because with ITP, both because their platelet counts can their platelet counts can drop and because of the drop and because of the bleeding involved with bleeding involved with delivery. delivery.

TheoriesTheories

Three most common theories for ITP are:Three most common theories for ITP are: The Microbial Trigger TheoryThe Microbial Trigger Theory The Molecular Mimicry Theory andThe Molecular Mimicry Theory and The Free Radical Damage TheoryThe Free Radical Damage Theory

The Microbial Trigger TheoryThe Microbial Trigger Theory

Links the destruction of platelets to a chemical Links the destruction of platelets to a chemical called interleuken 12 that is released when the called interleuken 12 that is released when the body is fighting a bacterial infectionbody is fighting a bacterial infection

They believe that in some people this They believe that in some people this interleuken 12 can inadvertently activate interleuken 12 can inadvertently activate dormant self reactive cells that then convince dormant self reactive cells that then convince your body that a cell near the bacteria is also your body that a cell near the bacteria is also part of the infectionpart of the infection

If that cell is a specialized platelet then you If that cell is a specialized platelet then you would develop ITP would develop ITP

The Molecular Mimicry TheoryThe Molecular Mimicry Theory

This theory says that someone can develop ITP This theory says that someone can develop ITP when the bodies T helper cells recognize a viral when the bodies T helper cells recognize a viral or bacteria amino acid sequence that happens to or bacteria amino acid sequence that happens to occur on the surface of a plateletoccur on the surface of a platelet

Normally T helpers that would target somatic Normally T helpers that would target somatic cells are inhibited by other immune agents.cells are inhibited by other immune agents.

If there is a malfunction in the production of If there is a malfunction in the production of these inhibiting agents then the self reactive T these inhibiting agents then the self reactive T helper cells are free to target platelets for helper cells are free to target platelets for destructiondestruction

Free Radical Damage TheoryFree Radical Damage Theory

DNA is damaged by “free radicals”DNA is damaged by “free radicals”Free radicals are compounds that build up Free radicals are compounds that build up

in the body, which need electrons in order in the body, which need electrons in order to become stableto become stable

If they steal these electrons from DNA If they steal these electrons from DNA they can cause mutations which could they can cause mutations which could effect the immunes system, and possibly effect the immunes system, and possibly trigger ITP or other Autoimmune diseases.trigger ITP or other Autoimmune diseases.

Diagnosis Diagnosis

ITP is often the Diagnosed by its’ symptoms. It is ITP is often the Diagnosed by its’ symptoms. It is frequently the diagnosis when all other blood frequently the diagnosis when all other blood diseases are ruled out and there seems to be diseases are ruled out and there seems to be the body mounting an attack against the the body mounting an attack against the plateletsplatelets

There are different forms of ITP. Some children There are different forms of ITP. Some children experience a disease which is listed as ITP experience a disease which is listed as ITP because it is thrombocytopenia with an unknown because it is thrombocytopenia with an unknown origin. However it differs from adult and chronic origin. However it differs from adult and chronic childhood ITP because many of these childhood childhood ITP because many of these childhood cases last only a matter of months and then go cases last only a matter of months and then go into permanent remission. into permanent remission.

ITP StatisticsITP Statistics ““Approximately 200,000 Approximately 200,000

people in the US have people in the US have ITP”ITP”

In Adults women are In Adults women are three times more likely to three times more likely to have ITP than men, but in have ITP than men, but in children the statistics are children the statistics are fairly evenfairly even

““The percentage rate of The percentage rate of ITP cases is increasing. ITP cases is increasing. Each year there are Each year there are approximately 20,000 approximately 20,000 new cases or about 10 to new cases or about 10 to 125 per million people.”125 per million people.”

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Adults Children

Men

Women

TreatmentTreatment

In most cases ITP is not fatal and can be treated. In most cases ITP is not fatal and can be treated. There is a wide variety of treatment options, but with only There is a wide variety of treatment options, but with only

partial success due to the unknown nature of the partial success due to the unknown nature of the disease. disease.

The most commonly excepted, and most successful The most commonly excepted, and most successful treatments for ITP involve the removal of the spleen treatments for ITP involve the removal of the spleen because it is a site for autoantibody production.because it is a site for autoantibody production.

People are also very commonly given Prednisone which is People are also very commonly given Prednisone which is an artificial steroid which can enhance platelet an artificial steroid which can enhance platelet productionproduction

For emergency case treatment (normally when platelets get For emergency case treatment (normally when platelets get below 20,000) They will administer IV G or intravenous below 20,000) They will administer IV G or intravenous gammaglobulin for several days, and they wait for counts gammaglobulin for several days, and they wait for counts to reboundto rebound

Sources Sources

Platelet Disorder Support Association Platelet Disorder Support Association www.ITPpeople.comwww.ITPpeople.com

Scripps Institute website Scripps Institute website http://seconde.scripps.edu/ltphttp://seconde.scripps.edu/ltp

Family Genetics.netFamily Genetics.net

www.familygenetics.netwww.familygenetics.net