Antibodies to TPO, receptor, platelets cause ITP

Jay:

I was going to ask if you were some sort of engineer. I can usually spot them pretty easily (distinct personalities).

There is a difference between ITP and thrombocytopenia. Thrombocytopenia is usually defined as low platelets with a known primary cause such as viral infections, chemotherapy, heavy alcohol use, etc. These types will usually go away when the person recovers. If there is no known cause, the diagnosis is ITP which is autoimmune-related.

I have no idea if your low platelets were caused by heavy alcohol use or not. I will not deny the possibility. All you can do is change your lifestyle and wait it out. I do believe that lifestyle changes such as diet and stress management can make a difference.

Thrombocytopenia is a frequent complication of alcoholism, affecting 3 to 43 percent of nonacutely ill, well-nourished alcoholics and 14 to 81 percent of acutely ill, hospitalized alcoholics. Thus, apart from acquired immune deficiency syndrome (AIDS), alcoholism probably is the leading cause of thrombocytopenia. Except for the most severe cases, however, the patients generally do not exhibit manifestations of excessive bleeding. Moreover, alcohol-related thrombocytopenia generally is transient, and platelet counts usually return to normal within 1 week of abstinence.

Therefore, patients generally require no therapeutic intervention other than that needed to ease alcohol withdrawal. Only in patients whose thrombocytopenia is severe and associated with
excessive bleeding are platelet transfusions indicated. In many patients with thrombocytopenia, rebounding platelet numbers even exceed normal values. This rebound thrombocytosis after cessation of alcohol consumption also occurs in the majority of patients whose platelet
counts are normal at the time of hospitalization. In these patients, the extent of the excess in circulating platelets usually is higher than in patients presenting with thrombocytopenia.

The exact mechanisms underlying alcohol-related thrombocytopenia remain unknown. Some researchers
have suggested that alcohol intoxication itself, rather than alcohol-related nutritional deficiencies, causes the decrease in platelet numbers. This view is supported by findings that
thrombocytopenia developed in healthy subjects who received a diet containing adequate protein and vitamin levels (including large doses of folic acid) and consumed the equivalent of 1.5 pints (i.e., 745 milliliters) of 86-proof whiskey for at least 10 days (Lindenbaum 1987). The subjects’ platelet levels returned to normal when alcohol consumption was discontinued. Similarly, platelet counts can be reduced in well-nourished alcoholics who do not suffer from folic acid deficiency. The available data also suggest that alcohol can interfere with a late stage of platelet production as well as shorten the life span of existing platelets.

Individual drinkers appear to differ in their susceptibility to alcohol-induced thrombocytopenia. Thus, clinicians have noted that some people who consume alcohol in excess repeatedly develop thrombocytopenia (often severely), whereas other drinkers maintain normal platelet levels. In addition to differences in the quantity of alcohol consumed, inherited
or acquired variations in an individual drinker’s biochemistry may account for
these differences in susceptibility.

pubs.niaaa.nih.gov/publications/arh21-1/42.pdf

Hay Jay, my highest medical credential consists of a C grade in high school biology, LOL

About IPT triggers and remission. Me-no-expert to properly answer your further questions. I think just terminology understanding can get you there though.

Consider that there are two disjoint diseases 1) Thrombocytopenia and 2) Immune Thrombocytopenia. Both have the symptom of low platelet count So if the disease is just Thrombocytopenia then the immune system isn't an issue and is not what I've described in the flu example.

There is indeed more to it all though (ref Sandi resp). For Immune Thrombocytopenia (ITP) there are two qualifying types, 1) Primary ITP and 2) Secondary ITP. If you look into the definition of these two types then it should be clear. Specifically, it should be clear that what I described is not Secondary ITP, it was Primary ITP.

How are we now, better?

Oh my Rob, pit bull?
That is a pretty wide spectrum of jobs. Interesting. I see that management is indeed in there. LOL, I wonder if we can change our username with the new revamped message board. Google-Fu-Research-Master would be fitting.

Pit bull only in that when I get my teeth into a question I can't let go until I've found the answer.
Don't worry... I don't bite!

Jay
I was drinking a lot due to stress probably about 30-35 units a week My LFTs were completely normal from the outset. .
I abstained for 3 months and it made no difference to my platelet counts to LFTs at all. I now drink much more moderately and again no difference to counts

Mrsb:
I think Hal's answer clarified many things for me.
So what is the trigger which has classified either TPO\TPO receptor\Platelet as a foreign body.
Even if we stopped drinking the attacking will continue.

Hal:
I spoke with two Hematologists, one is professor in RUSH.
Both of them are saying that 1 month of abstinence will tell whether you are ITP or TP.
In my case it is ITP.

Jay
I got very run down due to stress and ended up with the most horrendous viral sinusitis that lasted 12 days.
6 weeks later in hospital covered in bruises with a platelet count of 12.

Anne, if drinking doesn't affect counts, isn't that evidence that you have only a platelet destruction issue?

Your guess is a s good as mine. Indium scan showed splenic destruction of platelets but may be antibodies attacking production sites too.

I don't think it's possible to correlate drinking with production or destruction problems. Many heavy drinkers never experience platelet problems. Many who abstain never see ITP get better.

Drinking doesn't affect my count either. Despite copious red wine over the festive season, a current UTI and course of antibiotics my count has gone up to 83 on the 75 mg of eltrombopag . Maybe at my next visit to the clinic in a month the dose will be tweaked but I am wary in case of crashing. Hope you get a positive response too.

Sandi, I suspect you are correct. But have to wonder if it is a 'dominant issue' thing. That is, if drinking affects counts (production) by say 20%, and one's counts are only 15 - may well appear as though drinking has no affect on counts. A count of 12 versus 15 is easily in the vicinity of measurement noise.

There is no way to know that. Counts fluctuate constantly, and a difference of 5k doesn't matter all that much. If you're talking percentages though, the difference will be greater with higher counts. However, higher counts don't have to be treated so there isn't a problem there. If a person thinks that alcohol might be influencing production and they are worried about it, then the answer is simple: abstain. There are some things we can control. Personally, I think it is much more complex than that. Most articles don't discuss the occasional drinker, they talk about heavy drinkers, or alcoholics. In that case, the overall problem is bigger than just ITP.

Sandi,

I agree with your thesis. I was never a heavy drinker, Even on my worst times, a six pack beer three to four days a week max.

I think stress plays a major role I think.

I had a one very stressful legal incident on July13th, 2016 my symptoms started appearing August 13th.

Jay
My consultant told me to avoid stress as much as possible hence my job change to a much less stressful job . Unfortunately it hasn't helped my counts at all. However my sanity is much improved !!

I agree that stress can play a role. If it can cause heart attacks and strokes, it can certainly set off autoimmune disorders. Stress is known to exacerbate them. I think that there probably is a genetic predisposition though, and more than likely the stress was just the end of a cascade of triggers.
I was diagnosed after a bad cold and a period of prolonged stress.

Sandi, about cascade of triggers. I think I know what you mean but not sure. Don't want to prejudice your answer. What is your general thoughts about a cascade of triggers?

I believe my ITP came about after a nasty and very painful two week bout of Shingles on my trunk, probably brought on by stress.

I think my immune system thought "we've sorted that out - what do we do next - ahh! let's munch some platelets"

Sounds a bit silly but I am a firm believer in coincidence.

Sounds logical to me. After my husband died I became anorexic and lost an awful lot of weight. I have never managed to return the to weight I was before. That must have upset my immune system to some degree. 3 years later after an extremely stressful 6 months at work and I contracted sinusitis that knocked me for 6. I'm convinced my immune system had had enough and failed to switch off the antibodies that attacked the sinusitis so the went for my platelets.

Guys funny thing is I have basically gone back to my old ways except for drinking alcohol and monster energy drinks.
Iam back to running, my protein shakes.
I have put on 20 pounds but will cut that out fast.

No matter what I do, nothing works except NPlate.

If I drink alcohol or monster I think my wife will divorce me LOL.

Hal:
Although I do believe that one certain thing can trigger ITP such as an antibiotic or illness, I also believe that sometimes the body starts a spiral that can take months or years to show up. It all usually starts with the genetic predisposition. Many people with ITP have family members with other autoimmune disorders, so autoimmunity does run in families, but they usually don't all have the same one. My sister actually had ITP years ago though. I have cousins with MS. I have ITP and Lupus. My daughter has asthma and Graves. Two of my kids and me have had eczema, and I have a few cousins who had it as well. If you start asking around, you find out that there is more to the family medical history than you knew.

As far as the cascade, it could be that prolonged stress combined with a bad cold followed by Echinacea use triggered the whole thing. I don't think there is always just one certain thing that 'caused' ITP. Some people never figure it out because nothing seemed to happen prior to, and some people pick something to blame that might have just occurred. Maybe so, maybe not.

I have ITP, my youngest son is a Type 1 diabetic, my youngest grandson has horrendous eczema

Ok yea, definitely genetic predisposition. I was skimming through an article talking about all these auto immune disease being linked to (at least) one mutation. Apparently its a common mutation.

On cascading triggers, I was wondering if cascades are necessary, or that they are not. I'm getting you are thinking cascades may or may not be, as I do.

But I also wonder could cascades radically increase probability of disease? Think about children, who should have far shorter history to cascades. They get ITP but normally recover naturally in a short period of time. Now that I've written this down, it makes me think that long cascades just makes it harder to get rid of say ITP. LOL, with cascades the immune system has been corrupted more times. Maybe cascades don't affect probability, hmmm.