Wednesday, December 15, 2010

Blood disease attacks body’s ability to stop bleeding

A 16-year-old Paducah boy and a 72-year-old Hickory woman share a condition that could leave them unable to stop bleeding from a major wound.
Dr. Danny Butler of Paducah said  Derek Willett and Phyllis Dublin suffer from idiopathic thrombocytopenic purpora. He described the disease as an assault by the body’s own immune system on blood platelets. Platelets are the component of the blood that gather at wound sites and form blood clots, stopping the body from bleeding to death. Different from hemophilia, the body suffers only from sudden acute drops in platelet levels, not in clotting factor.
“Common side effects are bruising, nosebleeds, a black spot in the mouth and bleeding into the gums,” Butler said. “We usually diagnose with a platelet count.”
Butler said the cause of the disease is unknown. Some patients, like Dublin, experience severe bleeding. Dublin bled into her lungs, which could have caused her to drown. The condition is treated by suppressing the entire immune system through anti-inflammatory steroids such as prednisone. Once treated, Dublin’s lungs re-absorbed the blood.
“We don’t know why some people choose to bleed from a certain location.” Butler said. “It could be life-threatening. We have to always look at the platelet levels. If it’s low, we would not like to operate and have to treat.”
If blood platelet levels are low or a patient has suffered severe bleeding, a blood transfusion remains an option. Butler warned that even with a transfusion, the body’s immune system could attack blood platelets. In severe cases, surgeons could remove a patient’s spleen. The spleen removes blood platelets attacked by antibodies.
“It’s a little more common in women than men and people 65 or older,” Butler said. “A lot can trigger the immune system. For every organ, we’re finding auto-immune disorders. We have a lot of work to do.”
Willett said his physician discovered the disease in a routine blood screening in 2009. The junior at St. Mary High School in Paducah said he was undergoing a physical for cross-country running when doctors noted his low platelet count. He’s reported no major episodes of bleeding, but monitors his platelet count closely.
“Doctors say I should avoid head and other serious trauma, but I’m not on steroids at this point,” Willett said. “They won’t do that unless my platelet count falls below 20,000 because steroids affect other organs in a bad way.”
Willett said he has conducted several fundraisers for Vanderbilt University Medical Center to research ITP. He’s raised $600 with a bake sale, selling bracelets and with a donation jar. For now, he is mindful of potential risks and hopes he grows out of his condition.
Dublin said she’s had no major episodes since August, but blames ITP for periods of weakness and fatigue earlier in the year.
“It was difficult to breathe, no worse than that,” Dublin said. She said the difficulty hit her one day about 11 a.m. “By 12:30, I was in the ER fighting for my life,” Dublin said.
Dublin said she stopped at the Mayfield Fire Department for oxygen. An ambulance took her to Western Baptist Hospital for treatment.
“I haven’t had any problems since, and the doctor started me on 90 mg of prednisone,” Dublin said. “He moved me from 90 to 60 to 40 and 10. Now I take 5 mg every other day. The thing is, this can affect anyone at any age, and comes on with no warning.”
Willett told teens and people of all ages to have complete blood count exam to determine if platelet levels are low.

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