Disease Description (Causes and Pathophysiology, Main Symptoms)
- Definition: A disease in which platelets are destroyed through immune-mediated mechanisms (and decreased production may also occur), leading to a reduced platelet count and mucosal or skin bleeding and purpura (Immune thrombocytopenia, ITP).
- Causes/Pathophysiology: Autoantibodies (mainly IgG) target the platelet surface, causing destruction in the reticuloendothelial system of the spleen, liver, and other organs or shortening platelet lifespan. In some cases, decreased platelet production in the bone marrow also occurs. The acute form often develops after an infection or vaccination, while the chronic form is more common mainly in adult women.
- Main symptoms: Easy bruising (ecchymoses and petechiae), nosebleeds and oral mucosal bleeding, heavy menstrual bleeding, gastrointestinal bleeding, and, in severe cases, intracranial hemorrhage (rare but potentially fatal), which may cause headache, vomiting, and altered consciousness.
Treatment Methods (Standard Treatment, Medications·Procedures/Surgery, Lifestyle Management, Precautions)
- Treatment indications: Not every patient requires treatment. Treatment is generally determined based on bleeding symptoms or platelet count and individual risks (e.g., active bleeding, a planned procedure, or a high-risk condition). In general, treatment is considered in adults when the platelet count is <30,000/µL or when significant bleeding is present.
- First-line treatment
- Corticosteroids: prednisone 1 mg/kg/day (short-term, followed by tapering) or high-dose dexamethasone 40 mg/day × 4 days (intermittent administration may be selected).
- IVIG: 1 g/kg × 1–2 doses or 0.4 g/kg/day × 5 days — used for acute bleeding or when a rapid increase in the platelet count is needed.
- Anti-D immunoglobulin: Considered in Rh-positive, nonsplenectomized patients (not suitable for all patients).
- Second-line treatment (when steroids fail, the disease relapses, or there are concerns about the adverse effects of long-term steroid use)
- Splenectomy (a traditional treatment; selective and permanent remission may be possible)
- Platelet production stimulators (TPO agonists): romiplostim (injection), eltrombopag (oral) — effective for long-term management but require monitoring (liver function, excessive increase in platelets, and thrombotic risk).
- Rituximab (anti-CD20), immunosuppressants (e.g., mycophenolate, azathioprine), fostamatinib/new drugs (e.g., fostamatinib — a SYK inhibitor), etc.
- In emergencies or when bleeding occurs
- Platelet transfusions are used for life-threatening bleeding or temporary supplementation before surgery (platelets may be rapidly destroyed due to the immune process). Administered together with steroids/IVIG.
- Lifestyle management and precautions
- Avoid NSAIDs (including aspirin) and anticoagulants when they increase the risk of bleeding. Do not change medications without consulting a doctor.
- Limit activities with a risk of bleeding, such as contact sports and lifting heavy weights.
- Visit a hospital immediately if bleeding occurs. For life-threatening symptoms (severe headache, impaired consciousness, bloody stool, etc.), go to the emergency room.
- Long-term adverse effects of treatment medications (especially steroids), such as infection, osteoporosis, and diabetes, require monitoring. TPO agonists may increase the risk of thrombosis.
Checklist Before an Outpatient Visit (Including Items and Records to Bring and Example Questions)
- Items/records to bring
- A list of currently used medications, supplements, and herbal medicines (including doses and administration times)
- Recent blood test results (including the platelet count) or copies of test reports
- Records of past bleeding episodes (when, where, and whether treatment was received)
- Information about recent infections, vaccinations, surgeries, pregnancy, or contraceptive use
- Allergies (especially medication allergies) and a history of liver or kidney disease
- Information that is useful to record before an outpatient visit
- A symptom diary noting how often and where you usually bruise easily, nosebleeds, gum bleeding, menstrual changes, fatigue, dizziness, and other symptom changes
- Show the doctor in advance at the visit
- Whether surgery or a dental procedure is planned, and whether pregnancy is possible or planned
Examples of General Questions to Ask the Doctor
- What are the main side effects of this medication (e.g., steroids, IVIG, or TPO agonists)?
- At what platelet count level do I need treatment?
- What should I be careful about in daily life (exercise, work, and travel)?
- What is the long-term management plan for the medication or treatment (the remission goal and monitoring frequency)?
- Please tell me how to respond in an emergency if bleeding occurs and when I should go to the hospital.
Examples of Condition-Specific Questions
- Based on my platelet count and bleeding pattern, if I need surgery (or a dental procedure), to what level should my platelet count be raised?
- How does ITP management differ during pregnancy, and what risks are there for the mother and newborn?
- Do I need to be tested for Helicobacter infection, and if the result is positive, is there a possibility that platelet counts will recover with eradication treatment?