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Childhood ITP

(by Professor Sir John Lilleyman)

Questions answered by Professor Sir John Lilleyman in previous editions of 'The Platelet'

Q. My son was diagnosed with ITP at the age of 6 months and after 18 months his count rose to 150, and has remained around this level for the last 2 years. However, our hospital still wish to take blood tests every 2 months and will not sign him off. I would like him to go to school with a clean bill of health, so do you think that our consultant is being over cautious?
A. I have much sympathy with your sentiments and agree that, on the basis of what you say, the clinical team at your hospital is being a bit over cautious. Perhaps an annual visit just to keep the records up to date would be a reasonable compromise, with a promise of permanent discharge if no trouble for over (say) 3 years.

Q. I understand that ITP is a blood disorder in the form of an autoimmune disease. What is the difference between a disorder and a disease.
A. An interesting question. The words are often used interchangeably, but the word disease is more specific. It means a particular disturbance of normal bodily function as a response to environmental factors, infective agents (germs), inherent defects (such as genetic abnormalities), or a combination of these. The cause is often known and the condition is well defined. A disorder is usually less specific and relates simply to an abnormal physical (or mental) condition. Disorders are often groups of diseases - such as bleeding disorders, autoimmune disorders and so on. Hæmophilia is a disease which is an example of a bleeding disorder. Chronic severe childhood ITP is a disease which is an example of both a blood disorder and an autoimmune disorder. Your question emphasises the confusion and overlap.
Another commonly used word is syndrome, which is a recognisable collection of symptoms (what the patient feels, such as pain) and signs (what the doctor finds on examination, such as an enlarged spleen or high blood pressure). The word is sometimes used when the cause of a disease is not clear (example: flu-like syndrome when someone has the features of flu but does not have the flu virus).

Q. I have been told by an alternative therapist that my child should take Vitamin K supplements to help the blood clot but our doctor says that it will not help. Who is right?
A. Your doctor is right. Vitamin K supplements are only needed for patients deficient in the vitamin - such as newly born babies and older patients with serious liver disease. There is no reason why children with ITP should lack vitamin K, and if not deficient, they do not need supplements.

Q. My 6 year old son has chronic ITP and I worry every time he has a fall or complains of a headache that he may be suffering from internal haemorrhage. Although our consultant says that this is extremely rare can you tell me how to recognise the first signs of such a bleed?
A. Bleeding into the brain is extremely rare in uncomplicated childhood ITP and seldom, if ever, occurs without some underlying reason. Children, particularly toddlers, knock their heads regularly and come to no harm. If it occurs, the signs of bleeding are usually obvious - intense headache, drowsiness leading to a loss of consciousness, vomiting and weakness of one or other side of the body. These signs usually come on slowly enough to allow plenty of time for help to be sought. In the unlikely event you ever see such a problem you will be in no doubt that something serious is wrong.

Q. My daughter, was diagnosed with ITP shortly after receiving the MMR vaccine and although she has now recovered I am concerned that it may recur with any subsequent vaccinations and would like your advice please. Also is it possible that she would have got ITP from catching measles mumps or anyway, had she not had the vaccine.
A. ITP can certainly follow MMR vaccinations and when it does it is usually a brief ‘one off affair with no reoccurrence Do not be deterred from other immunisations. lTP, can occasionally follow mumps, rubella or (most commonly) chicken pox. Measles is now a very rare disease and thus irrelevant as a precipitating cause of ITP.

MMR and ITP

Q. Can ITP be the first sign of a more serious disease such as leukaemia?
A. No. ITP and leukaemia are totally different conditions and are completely unrelated to each other. Both can produce abnormal bruising and bleeding and can be occasionally confused until tests have been done to distinguish the two. Neither predisposes to the other.

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