Q: My father in law is 72 years old. His platelet count is 50 to 56 thousand since two years. Initially he had arthritis and knee pain and has taken many painkillers. The haematologist did a bone marrow biopsy, which came out to be normal but the smears show leucopaenia and thrombocytopaenia. The liver scan showed Grade II liver parenchyma hyperechogenic echo texture. I shall be thankful if you could kindly advise me the treatment?

A:Adult chronic immune thrombocytopaenic 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 (thrombocytopaenia) 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 auto antibody. This auto antibody 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 thrombocytopaenia, Immune thrombocytopaenia associated with other diseases like collagen vascular disease, lymphoproliferative disorders and infections need to be excluded. The other possibility to be excluded is a myelodysplastic syndrome especially as there is bicytopaenia. The CBC and bone marroe morphology would help in excluding this. 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. Treatment is given if platelet counts are persistently less than 25-30,000/ml). Initial treatment is by corticosteroids, i.v. gamma globulins or splenectomy.