Times of India
04 October 2011
By , Ankit Ajmera
Mumbai , India

An immune system disorder that prevents his blood from clotting didn't stop Vinitt Dhanu from resuming his normal tasks. He even went on to earn his sixth degree black belt

Vinitt Dhanu, a mechanical draftsman, has been an active person all his life. In February this year, the karate fanatic was about to appear for his sixth degree black belt exam. One day, while practising, he noticed a bruise on his forearm which turned purple very soon. On the second day, he spotted another bruise. As it did not hurt, Vinitt did not think too much of it. "I thought I had developed a skin problem," he says. On consulting the doctor, he was advised to undergo a full blood count test. Reports showed that he had developed Idiopathic Thrombocytopenic Purpura (ITP), a disorder of the immune system. "I was surprised because I have been healthy all my life," he says.

What is ITP?
Idiopathic Thrombocytopenic Purpura or Immune Thrombocytopenia is a condition which affects the platelets (small particles) in the body that induce clotting. Platelets are produced in the bone marrow. They are released in the blood stream and remain there for about a week before they are replaced by new ones. Whenever you cut or injure yourself and start bleeding, platelets come to the rescue by plugging themselves in the open wound, causing the blood flow to cease.

However, when a person develops ITP, the immune system of the body, for reasons unknown, starts producing antibodies which kill the platelets. As a result, the platelet count drops and the patient is always at the risk of excessive bleeding. Even a minor cut is dangerous. In case of a severe cut, the patient may bleed to death.

According to Dr Mukesh Desai, chief of immunology at BJ Wadia Hospital, 10 per cent of adults suffering from ITP, get cured automatically. But for 90 per cent of the people with the problem, it may become a life-long condition. "Only in one per cent of the cases, ITP becomes fatal," he says. "The disease is life-threatening in case of an internal brain injury where it is difficult to control the bleeding and for women, during their periods. But with medication, it's possible to live a quality life."

How ITP affected his life
At any given point of time, there are about 1.5 - 4.5 lakh platelets per micro litre of blood. Vinitt's platelet count had dropped to a meagre 13,000. Fortunately, he had not cut himself yet.

Vinitt was not too perturbed when he was diagnosed with the disease. "But I needed to learn to be very careful about simple, everyday tasks, as a single cut could have serious consequences," he says. Now he cannot afford to get a cut while shaving. He avoids going to crowded places, where there are chances of bumping against or into people and injuring himself. He cannot scratch himself if a mosquito bites him and has to brush his teeth very gently so that his gums don't start bleeding.

All this meant that from now on he will never be able to take up a fight in a karate match or ride a bike.
"Usually we do not hit below the waist while fighting. So I could have injured my nose, mouth or ears and bled. I am not afraid of bleeding. But I feel that the disease is holding me back from something I love," says Vinitt. "Also, I rode to office every day on my bike earlier. I can't do it anymore because there is a risk of accident." Instead, he is taking the office bus to work.

Treatment
Vinitt was put on steroids for the first few weeks of the treatment. Steroid medication is taken in the form of tablets or syrup and works by modulating the immune system to stop producing anti-bodies that kill the platelets. Steroids work fast and can boost the platelet count by thousands in less than 48 hours. Vinitt was taking three tablets of 20 mg steroids a day at the time of diagnosis. This improved the platelet count considerably. At present, his platelet count stands at 46,000. He has been taken off steroids now.

"Steroids, if consumed for long, can have adverse effects," says Dr Desai. "Weight gain, osteoporosis, high blood pressure and tuberculosis are some of the known side-effects. His medication has been changed to a steroid substitute which does not have severe side-effects." At present, he has to consume two tablets a day till his platelet count reaches above two lakh or more in the coming months. "Consuming pills daily is something I had never done and it makes me feel sick," he says. Vinitt exercises daily in the morning for an hour with his wife Swati Dhanu, who is a black belt (second degree) too. He is allowed to do all the exercises which involve stretching and muscle strengthening but he cannot indulge in a karate fight. Eventually, he was able to appear for the karate exam in Sri Lanka, three weeks later, but with a clause.

There were three stages to the exam: demonstration of basic karate techniques, an imaginary fight sequence and a real fight. Vinitt had to skip the third stage but was awarded the sixth degree black belt because of his past record.

How is ITP different from haemophilia?
ITP is an acquired disorder of the immune system where it starts destroying the platelets which are responsible for forming the initial clot in the wound. On the other hand, Haemophilia is a genetic disorder which impairs the body's ability to form strands of fibrin (a clotting protein) which strengthen the platelet plug for a permanent clot in the second stage. ITP can be treated by modulating the immune system or by stimulating platelet production in the bone marrow. The patient has to be on medication for a considerable period. However, as and when a Haemophilia patient gets a bleeding wound, he is give an injection of Factor VIII or Factor IX protein (depending on the genetic deficiency) which assists the fibrin in forming a permanent clot.