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What is the cause for low platelets count?

Q: I am 22 years old, suffering from low platelets count for the past 12 years now. The count goes down suddenly and then I have to undergo treatment, which includes a course of steroids (Defza 30). The course is as long as 6 months. The count remains alright for a year or more but after that I again have the same problem. Doctors say it’s hereditary and there is no permanent cure. I am worried, as I don’t know for how long I will have to go through this?

A:Adult chronic immune thrombocytopenic purpura (chronic ITP) is an autoimmune disorder in which patients produce anti-platelet antibodies that destroy their platelets leading to a low blood platelet count (thrombocytopenia) that may produce bruising or excessive bleeding. The disease is caused when normal proteins located on the platelet surface act as antigens and stimulate the immune system to produce autoantibody. This autoantibody then binds to the platelet protein, which signals the body’s defence mechanism to remove them. The spleen is the most important site of antibody production as well as platelet destruction and this is why splenectomy (surgical removal of spleen) helps. The diagnosis is one of exclusion and other causes like drug-induced thrombocytopenia, Immune thrombocytopenia associated with other diseases like collagen vascular disease, lymphoproliferative disorders and infections need to be excluded. Some patients recover spontaneously (within first few weeks) while about 5-10% have stable disease, with a platelet count of 30-100,000/ml, which may persist for months to years rarely requiring treatment. There is no universally effective treatment for chronic refractory immune thrombocytopenic purpura (ITP). Treatment is given if platelet counts are persistently less than 25-30,000/ml). This may happen with fever, infection, acute stress, intake of some drugs etc. Treatment is by corticosteroids, i.v. gamma globulins, rituximab or splenectomy. You would need to discuss all these issues with your doctor as he is best placed to advise you taking into account your clinical state.

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