diagnosis methods

[trinag]

i was diagnosed with itp in april 2012. i was 12 weeks pregnant at the time. i have since had ajealthy baby in sept 2O12. my hematologist advised me during pregnancy that itp was most likely pregnancy induced and would most likely go away up to 6 weeks after i had the baby. currently my platlettes hover from teens to twenties. i asked him about bone marrow testing and he said he didn't believe it necessary. his responce was if it has a trunk and is grey its an elephant. the only tests i have had to date are blood tests and heli bacter breath test. my question is has anyone had anything else in order to diagnos their itp? thanks

[AnthonyHeard Administrator ITP Support Association]

Hello trinag, ITP is diagnosed by process of elimination. They call it diagnosis by exclusion in that by a simple blood test they analyse it and then gradually exclude all the possible things that it can be, leaving ITP as the outcome once all else has been excluded. ITP does often occur following or during pregnancy and often it also goes away again without any treatment.

The only other test in connection with ITP which is used is a bone marrow biopsy where they take a sample of your bone marrow fluid and the actual bone marrow itself. They do this to make sure that your immune system is actually producing platelets correctly and it is done where the doctor/specialist may have some doubt about whether or not it is ITP or perhaps there are other medical issues that may raise his/her suspicions.

In ITP the immune system does produce platelets correctly but it also destroys them too for no know reason.Basically the immune system in ITP goes out of whack and thinks that our platelets are invaders/harmful so attacks them and destroys them , hence reducing our platelet count. The low platelet count is revealed by the blood test albeit you may get symptoms like bruising, bleeding from the nose, gums, urine, stools to indicate that your platelets are low and you may have ITP.

Hope this helps but do have a look at the website itpsupport.org.uk as it has plenty of general information including diagnosis, treatment options etc

[Hidden]

ITP can pretty well be diagnosed by looking at a blood film or smear under the microscope. In ITP the platelets will be few but large (although not giant) as they are all new platelets. In other disorders the platelets may be few but small showing that not many are made but they are also not destroyed quickly as older platelets are smaller. If nothing else is abnormal in the blood then ITP will be diagnosed.

If the first treatments don't work, usually steroids and maybe IVIG, then a bone marrow biopsy may be done to look for other things. But while they used to think that a bone marrow would show good production of platelets, they now know this to be false. So they will look for the production of the other blood cells to rule out things like myelodysplasia and leukaemia.

Bone marrow biopsies are only now routinely done on older people, over 60 or so as myelodysplasia is more common then, or sometimes in people who are about to have a splenectomy although splenectomy is going out of fashion too.

bloodjournal.hematologylibr...

[scaryteacher]

Hi Tinag,

I had a low platelet count when I was pregnant, and it didn't go away, contrary to what my Doc told me! I was told that the immune system gets out of whack during pregnancy and then just carries on like that - hence the ITP.

I was diagnosed in 1995, and have been fine since, only had to have steroids thrice in all that time, and manage it by being aware of my warning signs, which are the blood staining on my feet and legs darkening, the purpura rash appearing and getting very tired, but that has got more noticeable as I get older.

It seems scary at first, but you soon learn to just live with it, and as long as you go for blood tests every so often so you are aware of what's going on, then you just forget about it mostly.

[sailor]

HiTinag,

All good advice from regular contributors. Personally, I go with scaryteacher providing you know the dangers and symptoms and you are not bleeding involuntarily, get on with your life and don't let it ruin it. Make changes if you undertake dangerous sports or activities ( I gave up skiing,) and avoid putting yourself in danger. My count has been 10 for about 10 years, no medication unless necassary for procedures and now annual blood tests. Fatigue yes, if bad I take a power nap. Hope this helps.

[mags4743]

I had bone marrow biopsy to confirm ITP - but as CamdenGirl says I am over 60 so that was probably one of the reasons.

I'm with Sailor on this. Fortunately I don't bleed or bruise. I, like many others, was given prednisolone first which did work then didn't!! Second med. was Cyclosprine which also worked for a short time and then didn't! Third med. was Mycophenolate which I also took for a very short time but stopped because of side effects. Now I don't take anything at all and my platelets are currently 38 but have been 6. I have taken Sailor's advice and try to enjoy life. I am also type 1 diabetic so I have good days and bad.

If you want confirmation that you do indeed have ITP just ask you haematologist how he has drawn that conclusion i.e what aspect of the blood test has shown that you have ITP.

Good luck

p.s Your haematologist seems to have a sense of humour - tell him there is something else that is grey with a trunk....................a silver birch!!