ITP – Idiopathic thrombocytopenic purpura – and Pregnancy
What is ITP?ITP stands for Idiopathic thrombocytopenic purpura – you can see why it’s abbreviated! It is a disorder that leads to unusual or excessive bleeding or bruising and is caused by low levels of platelets. ITP is an autoimmune condition because the body attacks and destroys it’s own platelets as if they were an enemy, when they are in fact, quite a useful friend. Idiopathic means unknown and despite all the wonders of the medical world, scientists have absolutely no idea why in some people the body goes into overdrive and targets these perfectly healthy platelets. ITP is diagnosed with a simple platelet count in a blood test. In a normal adult, a count is 150,000 to 400,000 platelets per microliter. In someone with ITP, the count drops below 100,000 – 150,000 and can go all the way down to near zero at which point emergency treatment would be needed. When doctors are discussing results, they will just use the first three numbers – so if your number was 100,000 they would just tell you your platelet count is 100. My “normal” is around the 70 – 80 mark, which prior to pregnancy, had never required any treatment whatsoever – just an investigation that ruled out any other serious problems, and then regular monitoring to ensure it wasn’t doing anything crazy. Women are two to three times more likely to develop ITP, and ITP is also more likely to occur spontaneously during pregnancy, so it’s definitely something to be aware of.
SymptomsIf you have any of the following you should make an appointment with your GP to discuss and they may decide on a blood test.
- Excessive bruising or bruising extremely easy
- Petechiae – pinpoint red spots beneath the skin that look almost like a rash but is, in fact, superficial bleeding into the skin.
- Gums that bleed without a dental concern.
- Heavy menstruation.
- Blood in urine or stool.
TreatmentMost people with ITP do not need treatment unless the platelet count becomes excessively low. There are medications that can boost the platelet count but this is a temporary solution. A more permanent solution is a splenectomy, but this also has other side effects. Unless ITP is causing a serious problem, treatment is likely to simply be monitoring. There are some medications that you cannot take at all with ITP, as they lower your platelets even further, leading to higher risks. So if you have ITP, you need to double check every medication with your doctor to be sure. Some of this is a bit contradictory, for example I was told not to take aspirin ever before I was pregnant, but then advised to take it during pregnancy to help with pre-eclampsia (which I got anyway… nothing to do with the ITP though!). This is definitely an area you need to consult your doctors in. Ibuprofen (Advil, Mortin etc) can seriously lower platelets, so even if you’re buying a normal over the counter drug that you’ve taken before your diagnosis, you should now just double check to be sure – but you’ll also likely be given a list of the big no’s when you’re diagnosed. In an emergency if platelets are extremely low (usually below 20) you can be given intravenous immune globulin (IVIG) or a platelet transfusion.
ITP in ChildrenIn children, ITP is very often temporary and will cure itself with time and monitoring. It can happen following a viral illness, such as the flu or mumps. It’s thought that a serious infection can trigger the immune system into this malfunction that makes it target the platelets incorrectly. A baby can be born with ITP if the mother has ITP, as the antibodies are transferred through the placenta. If this is the case, it usually clears up in the first few weeks of life as the baby begins to produce its own healthy platelets, but in my research I did talk to another mother whose daughter had been in NICU for 6 weeks despite being born at full term and otherwise healthy, because of low platelet issues. Luckily my son was born with a platelet count that was lower than average, but not so low treatment was required.
ITP in Pregnancy, aka “Pregnancy induced thrombocytopenic”During pregnancy the body can get some mixed signals and platelet levels can drop. If you have not experienced platelet problems before, it’s no longer idiopathic thrombocytopenic, but pregnancy induced thrombocytopenic and this often returns to normal fairly swiftly after the birth. This can happen to anyone, with no previous problems with bleeding or bruising. If you, like me, are already diagnosed with long-term ITP as an adult, then the complications can vary from absolutely no change, miraculous improvement, or deterioration. It’s a bit of a pain all around because no one has any way of knowing, so you’re in for a fun ride of lots of blood tests and closer monitoring. For me, not knowing brought a lot of anxiety, so that’s something to be aware of, chat to the midwife to and get help for if you feel it’s starting to get overwhelming. If you have pre-existing ITP or develop PIT, then some things you’ll need to be aware of are:
- You’ll be marked as high risk and consultant led. You’ll be assigned a hematologist to go over your results.
- This can impact whether or not you are allowed a home or water birth depending on your situation and numbers – generally if diagnosed with ITP you’ll be expected to have a hospital birth as monitoring throughout the labour and after is necessary.
- You will need regular blood tests, most likely every 2-4 weeks depending on your results. Yup, for the whole pregnancy.
- You’ll need an appointment with an anesthesiologist who will go over any risk factors and what your results mean in terms of an epidural, spinal, c-section or general anesthetic. You’ll be given cut off numbers and if your numbers are too low, certain options are no longer available.
- You won’t be able to have internal monitoring of the baby during birth due to risks to them.
- You won’t be able to have a vacuum or forceps delivery due to risk to the baby.
- The baby will need a blood test at birth and may need treatment if they have also inherited ITP – but if they have, this will be temporary, not permanent.
- You have a greater risk of bleeding during the birth, so a higher chance of needing blood transfusion or treatment.