All about immune thrombocytopenic purpura, the rare blood disorder Mandy Moore suffers from


Mandy Moore, who is all set to welcome her second child with husband Taylor Goldsmith this fall, revealed that she will have an unmedicated delivery. The actor opened up about her autoimmune disorder called immune thrombocytopenic purpura (ITP) due to which she will not be able to get an epidural during childbirth.

“My platelets are too low for an epidural,” Moore told Today Parents in an interview.

The This Is Us star had given birth to her son Gus, who is now 17 months old, without medication, too, due to the condition. “It was awful. But I can do it one more time. I can climb that mountain again,” she said, recounting her experience.

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Moore added: “I wish medication was an option — just the idea of it being on the table is so nice. But we’ll just push forth like we did last time.”

What is immune thrombocytopenic purpura?

It is a blood disorder characterised by a decrease in the number of platelets in the blood. “Platelets are cells which are responsible for blood clotting. In thrombocytopenic purpura, the platelets go much below the normal range and clotting doesn’t occur; there are small bluish and reddish bruises under the skin. We call it ‘immune’ when there is no reason assigned to it or it hasn’t happened because of any medication or other disease,” explained Dr Meenakshi Ahuja, Senior Director – Obstetrics and Gynecology, Fortis La Femme, GK-II, New Delhi.

ITP is usually caused due to abnormal T and B lymphocytes that mistakenly attack platelets and reduce the counts, added Dr Vanajakshi Shivkumar, Senior Consultant – Obstetrician and Gynaecologist, Milann Fertility and Birthing Hospital, Kumarapark, Bangalore.

Causes

While the exact causes of ITP are not known, Dr Ahuja says that “it can be precipitated after any stress or infection in the body”.

Adding, Dr Sarang Goel, Medical Director, Ayu Health Hospitals, said that it can be caused by any trigger to the body’s immune system by viruses like HIV, Hepatitis, Mumps, Flu or bacterial infections like Helicobacter Pylori.

Symptoms

Dr Shivkumar listed the following common symptoms of ITP.

*Easy or excessive bruising.
*Superficial bleeding into the skin that appears as pinpoint-sized reddish-purple spots (petechiae) that look like a rash, usually on the lower legs.
*Bleeding from the gums or nose.
*Blood in urine or stools.
*Unusually heavy menstrual flow.
*Small bruises and petechiae over legs
*Excessive bleeding

“In severe cases, bleeding can also occur from the nose, mouth, and gums, along with in the upper and lower GI tract which, in turn, leads to blood in vomit and occult stools,” Dr Goel added.

ITP and childbirth

Experts pointed out that ITP can cause severe bleeding during delivery. “ITP and pregnancy can be dangerous. It can not only affect the platelets of the mothers but can also cross the placenta and attack the platelets of the baby. The pregnant woman will have a lot of bleeding and bruises on the body. During child delivery, there is a possibility of blood haemorrhage since the patient will lose a lot of blood,” Dr Ahuja explained.

It is managed, according to Dr Goel, “by supportive therapy with SDP and RDP before and after delivery, along with other IV medical management during delivery to prevent loss of life of the delivering mother”.

Prevention

While experts note that there is no known way to prevent ITP, here are some steps you can take to prevent complications, according to Dr Sarita Jaiswal, Senior Consultant – BMT and Haematology, Lead Consultant – Haploidentical BMT Program, Dharamshila Narayanan Superspeciality Hospital.

*Avoid medicines which will increase the risk of bleeding like ibuprofen and aspirin.
*Always ask your doctor before starting any new medication or supplement.
*Avoid contact sports which will lead to head injuries like boxing, football, and karate. Generally, swimming, cycling with a helmet, and walking are considered safe physical activities.
*If you’ve got any signs of an infection, especially fever, check your doctor immediately. Getting prompt treatment can help prevent complications.

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