Abstract
Idiopathic Thrombocytopenic Purpura (ITP) is an autoimmune condition characterized by a reduced platelet count in the bloodstream. It is an autoimmune disorder that results in reduced platelet count in the blood. It has varying incidence and prevalence rate depending on age and gender. In children,ITP occurs at a rate of approximately 1.9 to 6.4 cases per 100,000 children each year, with the condition most commonly affecting those between the age of 2 and 6. In contrast, adults experience lower incidences, with about 3 to 4 cases per 100,000 people annually. However, ITP tends to be more prevalent among women, particularly those between 20 and 50 years old. The prevalence of ITP is harder to pinpoint due to the chronic nature of some cases, but it is clear that ITP can affect individuals of any age. Immune Thrombocytopenic Purpura (ITP) can be correlated with Tiryagata Raktapitta in certain ways, especially in terms of their clinical manifestations and the underlying principles related to blood pathology.
Introduction
Idiopathic Thrombocytopenic Purpura (ITP) is an autoimmune disorder in which the immune system generates antibodies that target and destroy the body's own platelets (thrombocytes). This leads to purpura, characterized by small blood spots appearing under the skin due to bleeding. Under normal conditions, when a blood vessel is injured, hemostasis is activated to stop the bleeding. ITP can be a serious condition, the prognosis is generally favourable for most people, especially when the disease is diagnosed and managed early.
How ITP Causes Platelet Destruction
In ITP, B-cell activation triggers the production of IgG autoantibodies that specifically target platelet glycoproteins, such as GPIIb/IIIa and GPIb/IX. These antibodies coat platelets, marking them for destruction by the immune system. The immune system recognizes these antibody-coated platelets as non-self (foreign). Splenic macrophages (immune cells in the spleen) identify and bind to the antibody-coated platelets. The splenic macrophages engulf and destroy the antibody-coated platelets, leading to extravascular hemolysis. As platelet destruction increases, the number of platelets in the blood drops, leading to thrombocytopenia. This makes it harder for the blood to form clots, putting people at risk for easy bruising, bleeding and other complications such as hemorrhage in severe cases.
Types of Idiopathic Thrombocytopenic Purpura (ITP)
Types of ITP can be classified on the basis of the duration and underlying causes they are as follow:
1. Primary ITP (Idiopathic)
- This is the most common form of ITP and occurs without any underlying disease or known cause.
- It’s thought to be an autoimmune disorder where the body’s immune system mistakenly attacks and destroys its own platelets.
2. Secondary ITP
It occurs as a result of another condition or factor that triggers the immune system to attack platelets.
3. Acute ITP
- Often occurs in children, typically following a viral infection.
- Symptoms develop suddenly and are usually severe but often resolve on their own or with short-term treatment.
4. Chronic ITP
- It is a long term condition that persists for more than 12 months.
- It can affect both adults and children.
- It often requires long-term treatment.
5. Persistent ITP
It is a form of ITP that lasts for 3 to 12 months.
Causes of Idiopathic Thrombocytopenic Purpura (ITP)
The exact cause of Immune Thrombocytopenic Purpura (ITP) is often unknown, especially in primary ITP, but there are several factors that can contribute to its development. Here are the main causes:
1. Primary ITP (Idiopathic)
It is thought to be autoimmune. Its exact cause is unknown.
2. Secondary ITP (due to underlying condition)
- Viral Infections: HIV, Hepatitis C, Epstein-Barr, CMV, Varicella-zoster.
- Autoimmune Diseases: Systemic lupus erythematosus (SLE), Rheumatoid arthritis.
- Medications: Heparin, Quinine, Penicillin, Chemotherapy drugs.
- Post-Viral/Infectious: Can develop after viral infections, especially in children.
- Lymphoproliferative Disorders: Lymphoma, Leukemia.
3. Genetic Factors
Family history of autoimmune conditions or ITP may increase the risk.
4. Environmental Factor
Infection, stress or vaccination may trigger ITP in some cases.
Signs and Symptoms of Idiopathic Thrombocytopenic Purpura (ITP)
Early recognition of signs and symptoms can help in early detection of ITP, they are as follow:
- Easy Bruising - Frequent and unexplained bruise from minor bumps, due to low platelet count.
- Petechiae - Small red or purple dots on the skin, often appearing on legs or feet, caused by tiny blood vessel rupture.
- Purpura - Large purple or red patches on the skin from bleeding under the skin, usually without injury.
- Prolonged Bleeding - Extended bleeding from cuts, scrapes, or minor injuries, and frequent nosebleeds or gum bleeding.
- Heavy Menstrual Bleeding (Menorrhagia) - Women may experience unusually heavy or prolonged menstrual problems.
- Fatigue - Feeling usually tired or weak.
- Internal Bleeding - Symptoms of internal bleeding such as blood in the urine or stool.
- Enlarged Spleen (Splenomegaly) - In some cases, the spleen may become enlarged, causing discomfort in the upper left abdomen.
Diagnosis of Idiopathic Thrombocytopenic Purpura (ITP)
Diagnosis of ITP involves a series of steps to confirm a low platelet count and rule out other potential causes of thrombocytopenia. They are as follow:
- Medical history
- Physical exam to check common signs of ITP such as bruising, petechiae, purpura, as well as enlarged spleen.
- Blood tests
- Complete blood count (CBC)
- Peripheral blood smear
- Antibody testing to check autoantibodies against platelets.
- Imaging tests
- Ultrasound
- CT scan
- Rheumatoid Factor and ANA (if suspected autoimmune cause) - Tests for autoimmune conditions like Systemic Lupus Erythematosus (SLE).
Management of Idiopathic Thrombocytopenic Purpura (ITP)
Management of ITP involves a range of treatments aimed at increasing platelet count, reducing immune-mediated platelet destruction, and preventing bleeding. Treatment of ITP involves:
1. First-line Treatments
- Corticosteroids (e.g., Prednisone): Suppress immune response to increase platelet count.
- IVIg: Rapid platelet increase, especially for bleeding or surgery.
- Anti-D Immunoglobulin (for Rh-positive): Alternative to IVIg for raising platelet levels.
2. Second-Line Treatments
- Rituximab: Targets B-cells to reduce autoantibody production.
- Thrombopoietin Receptor Agonists (Eltrombopag, Romiplostim): Stimulate platelet production in the bone marrow.
3. Platelet Transfusion
Used in severe bleeding or extremely low platelet counts.
4. Supportive Care
Avoid injury and monitor platelet counts regularly.
5. Surgical Option
Splenectomy: Removal of the spleen to reduce platelet destruction in chronic cases.
Complications of Idiopathic Thrombocytopenic Purpura (ITP)
- Intracranial bleeding
- Subarachnoid haemorrhage
- Gastrointestinal haemorrhage
- Hematuria
- Severe menorrhagia
Ayurvedic Aspect
According to ayurveda, Raktapitta occurs when pitta contaminates the rakta due to its ushana guna (hot quality), causing it to leak from the body through various routes. This condition is categorised into three types based on the direction of the blood flow. They are as follow
- Udharvagata raktapitta - Caused by the snigdha (oily) and ushna (hot) qualities of Pitta, leading to bleeding from upward orifices like the mouth, nose, ears, and eyes.
- Adhogata raktapitta - Triggered by hot and dry food, which vitiates vata and pitta, causing bleeding from lower orifices such as the rectum, vagina and urinary tract.
- Tiryak gata raktapitta - When all doshas are aggravated, wrestling in bleeding into the subcutaneous tissue and skin, causing bruising or petechiae.
Idiopathic Thrombocytopenic Purpura (ITP) can be associated with tiryak raktapitta. The clinical representation of tiryak raktapitta aligns with the symptoms of ITP, especially the subcutaneous bleeding and easy bruising. When certain nidanas (factors) are consumed, they aggravate the pitta dosha. This contamination of pitta mixes with the blood, causing it to become impure. The hot nature of pitta causes the liquid element of other tissues like mamsa dhatu (muscle) and meda dhatu (fat) to leak out of their respective tissues and mix into blood. This increases the amount of rakta dhatu (blood) beyond its normal level. As a result, the volume of the blood flowing through the blood vessels increases, creating excessive pressure. The heat from the pitta combined with high blood pressure weakens the wall of the blood vessel, causing them to rupture. This leads to blood leaking out through various orifices of the body, such as the mouth, nose, ears, eyes, skin, anus, penis and vagina, these are the body`s nav dwar (nine opening). This leakage of blood contaminated by Pitta through these orifices is called Raktapitta. When the blood becomes even more vitiated, it can flow out through Romakupa (hair follicles), which is known as Tiryak Gata Raktapitta. This is a condition dominated by Pitta, which can eventually evolve into a Tridoshaja Vyadhi (a disorder involving all three doshas) with Pitta being the primary dosha involved.
Samprapti (pathology) ghatakas (components)
- Dosha (humor) - Pitta Pradhana Tridoshaja
- Dushya (affected tissues) - Rakta (blood), Rasa (plasma), mamsa (muscle), Sira (blood vessel)
- Agni (fire) - Jatharagni (digestive fire), Dhatvagni (metabolic fire), Bhutagni(fire that possesses elements)
- Aama(toxin) - Kostha (stomach)
- Srotas (channel) - Raktavaha (channel carrying blood), Rasavaha (channel carrying plasm), Annavaha (channel carrying food) and other Srotas according to Avastha.
- Sroto Dusti - Sanga (congested), Vimarga Gamana (improper movement) and Atipravrutti (excessive flow)
- Adhistana (location) - Yakrut (liver) and Pliha (spleen)
- Vyaktasthana (site of manifestation) - Tiryaka Bahya Srotas
- Rogamarga (path of disease progression) - Bahya (outer) and Abhyantara (interior)
Management (according to ayurveda)
In ayurveda, the treatment would focus on balancing pitta, promoting blood health and purifying the body of toxins. Pitta and rakta (blood) pacifying drugs such as Guduchi (Tinospora cordifolia), Kutaj (Holarrhena antidysenterica), Ashwagandha (Withania somnifera) and Brahmi (Bacopa monnieri). Panchkarma therapies such as virechana (purgation) and raktamokshana (bloodletting) can be used in detoxification of the body and cleansing blood. The combination of cooling, detoxifying and immune strengthening herbs along with proper lifestyle modification can help manage these conditions effectively.
Herbal Remedies for ITP by Planet Ayurveda
Planet Ayurveda is a GMP-certified company, meaning they carefully craft all their products with the highest quality herbal extracts, under expert supervision. They take pride in creating preservative-free products to help minimize the risk of any side effects. One of their offerings, the ITP Level-1 (Basic Pack), is specifically designed to help manage ITP with natural, herbal support.
- Plato Plan Syrup
- Ashwagandha Capsules
- Punarnava Mandur
- Hemo Plan Syrup
- Suvarna Basant Malti Ras
ITP Level-1 (Basic Pack)
Product Descriptions
1. Plato Plan Syrup
It is a herbal formulation offered by Planet Ayurveda, designed to support overall health and wellness. It contains a blend of natural herbs such as Giloy (Tinospora cordifolia), Erand Karkati (Carica papaya), Ashwagandha (Withania somnifera), Amalaki (Emblica officinalis) and several other herbs. This syrup is often used to assist in managing conditions like ITP (Immune Thrombocytopenic Purpura) by boosting the body's immune response and supporting platelet production.
Dosage - 2 teaspoons twice a day.
2. Ashwagandha Capsules
These capsules are a popular herbal supplement made from the standardized extract of ashwagandha (Withania somnifera). Ashwagandha is often utilized for its immune-boosting, anti-inflammatory, and adaptogenic properties. Individuals with ITP often experience fatigue due to low platelet counts or the side effects of medications. Ashwagandha is known to improve energy levels and combat fatigue, supporting overall physical and mental well-being.
Dosage - 1 capsule twice a day.
3. Punarnava Mandur
It is a traditional Ayurvedic formulation that combines several powerful herbs, including Punarnava (Boerhaavia diffusa), Shunti (Zingiber officinale), Pippali (Piper longum), Maricha (Piper nigrum), Amalaki (Emblica officinalis), Haritaki (Terminalia chebula), and several other herbs.This combination is used to promote overall health and manage various conditions, including Immune Thrombocytopenic Purpura (ITP), by supporting platelet production and overall immune function.
Dosage - 2 tablets twice a day.
4. Hemo Plan Syrup
It is a herbal formulation that contains a combination of potent Ayurvedic herbs such as Manjistha (Rubia cordifolia), Shatavari (Asparagus racemosus), Gorakhmundi (Sphaeranthus indicus), Draksha (Vitis vinifera), and several other herbs. This blend of herbs is known for its ability to support blood health and manage various conditions, including Immune Thrombocytopenic Purpura (ITP).
Dosage - 2 teaspoons twice a day.
5. Suvarna Basant Malti Ras
It is a traditional Ayurvedic formulation known for its rejuvenating, immune-boosting, and blood-purifying properties. It is typically used to address a variety of health concerns, including immune disorders and blood-related issues. This formulation plays a vital role by modulating the immune system, helping to reduce the immune response that destroys platelets. It helps in detoxifying the body, ensuring that toxins are efficiently removed and circulation is improved.
Dosage - Take 1 tablet daily, chewed with lukewarm water.
Conclusion
In this article I have concluded about Idiopathic Thrombocytopenic Purpura (ITP). We discussed its causes, types, symptoms, pathogenesis, diagnosis, management, complications, ayurvedic aspect and its herbal remedies by planet ayurveda. In both ITP and tiryak raktapitta, ayurveda focuses on restoring pitta balance, purifying the blood and addressing any underline ama (toxin) in the body.
