ITP is one of the exceptional autoimmune disorders that origins with the complaint of low platelet levels. Platelets are tiny blood cells that help to clots and stop bleeding in normal conditions. But in people with ITP, the body produces antibodies that attack and destroy the platelets. Antibodies are produced by cells of the immune system and are normally part of our system for fighting infection.

The two categories of ITP are:

  • Acute ITP – this is mostly a disease of childhood and accounts for nine out of 10 cases of ITP. It is far less common in adults, who are more likely to have chronic ITP. Sometimes a viral infection (such as a cold) seems to trigger the condition. The disease goes away by itself within two to six months
  • Chronic ITP – this ongoing form accounts for most ITP seen in adults and is far less common in children. Chronic ITP has similar symptoms to acute ITP, except that it lingers for longer than six months.

ITP can be correlated with Tiryaga Raktapitta on the basis os signs and symptoms as in this disease all the Dosas are vitiated and are circulating in the bloodstream and manifested subcutaneously. Raktapitta is a bleeding condition where the blood (Rakta) vitiated by Pitta flows out of the (openings) of the body.

Breakdown of the immune system and ITP

The body’s immune system is a dedicated arrangement of cells and chemicals that fight infections. Normally, the immune system recognizes ‘self’ and doesn’t attack tissues or organs of the body.

Generally infections speed up the person’s lymph tissues and spleen (an organ that helps filter the blood) to make antibodies that attack the platelets in their blood. Antibodies attack the body are called autoantibodies. In other cases, the cause is unknown (idiopathic).

Platelets are fragments of cytoplasm that are derived from the megakaryocytes of the bone marrow, which then enter the circulation. Since ITP targets mature platelets as they circulate through the spleen, the ‘newborn’ platelets inside bone marrow are healthy and normal. In many cases of acute ITP, the platelet count will rise again within a few weeks and return to normal within a few months.

Age Factor

More common among children than adults, most often occurring around two to four years of age. Estimates suggest that ITP affects one in every 10,000 children. Among adults, young women are more likely to develop ITP than any other group, for reasons unknown.

Symptoms of ITP

In most people with mild ITP, there are no symptoms and they will feel perfectly well. However, if the platelet count drops very low, they may experience an increase in bruising or bleeding. These symptoms may include:

  • Skin that bruises very easily
  • A skin rash of small red dots (petechiae), which does not blanch (go pale) with pressure
  • Bleeding from any area of the body
  • Bleeding from the gums
  • Frequent nosebleeds that take a long time to stop
  • Internal bleeding
  • Long or heavy menstrual periods.
  • Investigation

    These tests may include:

    • Blood tests – such as a Complete blood count (CBC) to check for platelet numbers, to see if there are abnormalities in other blood counts, or to see if the blood cells look normal under the microscope
    • Bone marrow biopsy – doctors remove a small sample of bone marrow through a needle and then check it in a laboratory. In a person with ITP, the platelets produced in the bone marrow should be normal. This test is rarely needed to diagnose ITP and is used only when strictly necessary (such as when there is some uncertainty of the diagnosis)
    • Other tests – to rule out other conditions that may cause a low platelet count, such as acute leukemia and aplastic anemia.

    In addition to these tests, doctors diagnose ITP by taking the person’s medical history and doing a physical examination.

    Treatment for ITP

    Anticoagulation and Antineoplastic approach has been followed in ITP.

    As per the classical text of Ayurveda, Akika, Akik Pishti processed with Gulab or ketaki or Chandana is the one of the first choice of treatment protocol. Due to its classical indication in Pitta roga, Rakta pradara, bleeding gums, Rakta pitta, Raktasrava and Rakta shtivana.
    Raktastambhana (To stop bleeding) and sankochna(Narrowing) properties of Shudha Sphatika is indicated  and recommended for sitz bath in few patients.

    Anticoagulation and Antineoplastic activity reduces the Sangrahi (astringent) factor, increases Balya (strength), Agnidipana (increases digestive fire), and Tridoshshamaka.

    Classical Churna like Ashwagandha, Amalaki, Shatavari, Yashtimadhu, Shweta musali, Bala, Gokshura, Sharkara has the property of Rasayana and Balya so it strengthens the immunity and helps in reducing the immunologic destruction of platelets.
    Herbs having Raktapitashamaka and Rasayana improves health by increasing immunity, vitality, and resistance.

    Herbal grass (Durwa) has the property of hemostasis, refrigeration, and healing so externally it is used in wounds, hemorrhages, burning sensation (like urticaria, erysipelas) and depigmentation of skin

    A combination of herbs having an erythropoietic activity are also advocated in menorrhagia. These contain Oligospirostanoside referred to as Immunoside which has an action of anti-inflammatory actions.

According to Ayurvedic classics, Raktapitta is classified into the following types

  1. Urdhvaga:- Causative features are Snigdha and ushna guna which vitiate the combination of Kapha and pitta and oozing of contaminated blood occurs from upward passages or orifices i.e. from mukha (mouth), Karna (ears), Akshi (eyes) and Nasa (Nostrils).
  2. Adhoga:- Characteristics are Raksha and ushna guna which causes vitiation of Vata and pitta and oozing of contaminated blood occurs from downward passages or orifices i.e. from Anal, Vagina  and urinary system.
  3. Tiryaka:- When all the dosas are vitiated and are circulating in the bloodstream, the manifestation is subcutaneous.(Skin)