ITP (ER Story) Marc Straus | CWK Network

“90 percent of these children will be spontaneously cured, and the disease will be gone within 6 to 8 months.”

– Dr. Lonnie King, Emergency Pediatrics, Children’s Healthcare of Atlanta

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Some childhood illnesses can appear without warning, scaring parents and doctors... and then, for no apparent reason, all the symptoms suddenly disappear.

That’s what seems to be happening to 10-yaer-old James, who came into the ER complaining of headaches, lethargy and bruising.

Doctor Lonnie King, of Children’s Healthcare of Atlanta examined James and notes that the bruises aren’t typical. They appeared spontaneously all over his body, and are signs of ‘ITP’.

Dr. King explains that ITP is, “ Idiopathic Thrombocytopenia Purpura. Idiopathic means: unknown case. We don’t know what causes it. And the thrombocytes are the small cells, or pieces of cells in the blood stream that help clot. Penia means low. And purpura is bruising. So he had bruising, because had had low platelet count of unknown cause.”

ITP is an autoimmune disorder: the body’s immune system attacks platelets that enable blood to clot.

A normal platelet count is 150-thousand or more, but James’ count was only 10,000 a few days ago… so low the doctor is worried about internal bleeding.

Doctor King explains to James’ concerned parents that the first step in treatment is to, “Prove that [James] doesn’t have a ruptured blood vessel, and see what his platelet count is, and we’ll talk to the hematologist.”

In rare cases a low platelet count can result in a ruptured blood vessel in the brain. So Doctor King orders a blood test and CT scan.

The results are quickly back, and they appear encouraging. “This is James’ CAT scan. And it looks totally fine,” says Dr. King, as he examines the brain images.

And his platelet count is rising. Dr. King gives the news to James and his parents. “Hey James, CAT scan’s normal, okay? And the platelet count is 56-thousand. It’s way up! So it’s good. So I think… you’re much, much better!”

That’s the way ITP is. In kids especially, symptoms can last a few days and then mysteriously go away.

“90 percent of these children will be spontaneously cured,” explains Dr. King, “and the disease will be gone within six to eight months.”

With a normal CT scan and increased platelet count, James can go home. But he’ll have to return to his doctor for regular checkups and blood tests, to monitor his condition.

Dr. King points out that the unexplained bruising associated with ITP often can be misdiagnosed as child abuse. He says if parents notice such bruising on their children, they should immediately ask the doctor to check for ITP.

By Larry Eldridge
CWK Network, Inc.

Discovering that your child has immune thrombocytopenic purpura (ITP), sometimes known as idiopathic thrombocytopenic purpura, can be very overwhelming. It can also lead to a lot of questions and concerns, some of which you may not think of immediately. Experts at the Platelet Disorder Support Association (PDSA) have developed the following list of questions you may want to ask your child’s pediatrician:

  • How much experience have you had treating patients with ITP?
  • How many ITP patients do you treat? How are they doing?
  • Are you affiliated with any research group or hospital that specializes in ITP?
  • Do you have an emotional support group or know of one for parents of children with ITP?
  • Can you give me the names of other parents of children with ITP I can talk to?
  • What is your treatment philosophy – conservative, moderate or aggressive?
  • What are your usual treatment recommendations for ITP?
  • What course of treatment do you suggest in my child’s case?
  • What has been the record of success for this treatment and how was it measured?
  • How long will my child need this treatment?
  • How will the treatment be administered?
  • What is the criteria for discontinuing the treatment?
  • Is this treatment designed to raise my child’s platelet count temporarily or permanently?
  • What will you recommend next if the treatment fails?
  • What are the side effects of the treatment?
  • For which side effects should I contact you?
  • Are there any precautions that can be taken to minimize the side effects?
  • Can you give me the name of someone else whose child had the treatment?
  • Will my child develop other medical problems from this treatment?
  • How will you monitor the treatment progress?
  • Do you have or know of any articles or other sources of information about the treatment?
  • What changes should I make to my child’s activities as a result of his/her ITP?
By Larry Eldridge
CWK Network, Inc.

Always seek the recommendations of your child’s pediatrician in regards to dealing with his/her ITP. In addition to those recommendations, experts at PDSA have developed the following list of suggestions:

  • Check your child's skin for bruises or petechiae ( broken capillary blood vessels) during baths.
  • Assist your child with using the restroom or stress to him/her the importance of reporting blood in bowel movements or urine immediately. Blood in the urine may be red or brownish (tea- or Coke®-colored). The same is true for blood in the vomit. Blood in the bowel movement may look red or black like tar.
  • Watch for bleeding from the mouth or nose, especially during dry air season. Check the bed linen for signs of bleeding while sleeping. Encourage only gentle nose blowing, never closing off one side to blow the other. Use the softest toothbrush possible. Avoid dental floss until the platelet count is up.
  • Report any blows to the head, belly or back to your doctor or hospital promptly.
  • Avoid giving your child medications until discussed with your doctor or nurse practitioner. Many over-the-counter pain, cold and cough medicines can affect your child's platelet function. Aspirin or any medicine containing salicylates (like Pepto-Bismol® or Alka-Seltzer®) should be avoided. Ibuprofen and strong antihistamines should also be avoided. Acetaminophen products (Tylenol®, Tempra®, etd.) are safe to give to your child for fever or pain while the platelet count is low.
  • Encourage plenty of fruits, fruit juices, water and fiber foods to avoid constipation. Hard bowel movements, enemas or suppositories can cause rectal bleeding. If needed, a stool softener may be recommended by your doctor or nurse practitioner.
  • Use plenty of toothpaste on a very soft bristled brush, and brush slowly and gently. You may need to assist or supervise your child. For infants, use a soft cloth or swab without toothpaste.
  • Use lip balm to keep lips from drying and cracking. Use saline nose spray (Ocean Spray® etc.) if needed to moisten nasal passages during dry weather to help prevent nosebleeds. Room or house humidifiers can also be helpful.
  • It can be helpful to run a soft washcloth under water and stick it in a bag in the freezer so you will always have an 'instant cold pack'. For nosebleeds, run the frozen cloth under cold water until soft and apply it with firm pressure to the nostrils.
  • Use lotion on dry skin to avoid your child's itching and scratching that could lead to bruises and petechiae.

For parents of active children, ITP can be especially worrisome. Experts at PDSA suggest the following for parents of busy, active children:

  • Do not allow your child to play roughly. This includes any contact sports such as wrestling, boxing, karate, soccer, and, possibly, basketball or baseball. A good rule of thumb when deciding if an activity is okay for your child is to allow anything within reason where the child's feet never leave the ground. This usually excludes bikes, motorcycles, skates, swings, etc.
  • Avoid toys with sharp edges, drinking straws or popsicle sticks.
  • Pad the sides of cribs. For older children who may fall out of bed, put their mattress on the floor or put a side rail between the mattress and box spring.
  • For small children, pad the corners of furniture and counters. Use a gate at the top or bottom of stairs. Clear obstacles such as tables or chairs that you frequently have to go around.
  • Take up loose rugs. Use rubber no-slip mats in the shower or bath.
  • Older children should avoid shaving with razor blades. Electric shavers used gently are usually okay.
  • Always put a seatbelt around you and your child. Use a car seat for smaller children.
  • Avoid travel in non-pressurized aircraft.

Children’s Healthcare of Atlanta
Children’s Healthcare of Atlanta Emergency Services
Platelet Disorder Support Association