Diagnosis of ITP
They key of diagnosing ITP is to exclude all other causes of bleeding disorders. Your physician will order a full workup consisting of a complete blood count to make sure that only platelet number is affected. If the count of red blood cells or white blood cells are also affected, it can’t be immune thrombocytopenic purpura and another cause is sought. It may also be necessary to perform a clotting test to make sure that the coagulation system is intact. It is done by a simple slice in the ear lobe or the forearm and if it turns out that the coagulation system is also impaired, the diagnosis of ITP becomes either wrong or incomplete.
Your doctor may also screen for viral infections that may have triggered the condition once the diagnosis is established. Although it can result from minor viral diseases, the possibility of more severe viruses such as hepatitis C or HIV remains.
Other diseases that may present with the same complaint include:
- Drug-induced bleeding: History taking is essential in the medical practice and an overdose or even a normal dose of an antiplatelet drug such as aspirin or an anticoagulant drug as warfarin can cause the same problem.
- Liver disease: Liver diseases can affect both platelets and coagulation since most coagulation factors are manufactured by the liver, and platelets need a protein called thrombopoietin which is chiefly produced in the liver.
- Bone marrow disorders: The bone marrow is the main manufacturing plant for platelets and conditions affecting it will surely cause a fall in platelet numbers. Examples include bone marrow fibrosis and aplastic anemia.
- Cancers: The effect of cancer on the bone marrow is very complex, but some cancers, as in leukemias, exert a direct effect through the invasion of the bone marrow by immature cells that encroach on the mother cells of platelets. Also, tumors release many inflammatory mediators negatively affecting platelet formation in what we call a “tumor microenvironment”.
- Disseminated intravascular coagulation: It is a combined platelet and coagulation factor disorder. It occurs because the body was exposed to an inflammatory or excitatory cause that led to the formation of several clots, consuming both platelets and coagulation factors and causing deficiencies. It is seen in some cases of abortions, severe infections especially in the newborn, and severe bleeding as in road traffic accidents.