Immune thrombocytopenia, here are the sports allowed for young patients

Sporting activity, a source of physical and mental well-being for everyone, should be particularly considered for some frail patients, such as people with immune thrombocytopenia (Itp), a blood disease that can cause haemorrhagic events. Also known as idiopathic or immune thrombocytopenic purpura, or even immune thrombocytopenia, ITP represents a rare form of autoimmune coagulation disease. Due to an immune system that produces antibodies against its own platelets and destroys them, ITP is characterized by a lack of platelets in the blood (thrombocytopenia or thrombocytopenia) with values ​​<100,000 / mm3, in the absence of other associated pathologies. The bleeding symptoms vary considerably and are often directly related to the platelet value: it can go from mucocutaneous bleeding (petechiae and ecchymosis) to severe gastrointestinal or cerebral haemorrhages, much rarer (0.1-0.4% in patients with platelet count <20,000 / mmc) but potentially fatal. In about one third of cases, the disease develops asymptomatically. Although national guidelines for the management of patients with ITP are available, recommendations on daily activities and sports for pediatric patients are mainly based on 'common sense' and experience of the individual Care Center. "Having to face a pathology for which the resolution times are not known, it is important that patients, but also their parents, are adequately informed about possible daily activities, including play and sport", he explains to 'Allies for Health 'Marco Spinelli, doctor of the Pediatric Hematology Unit - Pediatric Clinic Day Hospital, at the S. Gerardo hospital in Monza. The approach must therefore consider the age and type of trauma that may be incurred. The main risk for patients with ITP stems from the fact that simple traumas and injuries can represent a serious danger to health. In fact, the consequence of low platelets, a typical condition for those suffering from this pathology, is the alteration of the correct blood coagulation mechanisms and, consequently, the arrest of bleeding. "However, we must take into account - continues Spinelli - that the risk of trauma exists for any person who plays sports. The risks associated with the absence of physical activity - overweight, diabetes, etc. - are the same for everyone. It is therefore advisable to practice sports in moderation, except in the presence of Itp serious and associated with major bleeding. The right compromise is reached with the choice of the appropriate sport and adopting, when necessary, appropriate protection. "" Preschool children who attend the nursery and kindergarten do not risk major trauma if not unconsciously exposed from parents - Spinelli observes -. They can fall from their height while playing, they can fall off the sofa, they can accidentally hit a hard surface (wall, floor, wardrobe), they can be accidentally hit by an object thrown by a partner, etc. All these episodes involve bruising and no increased risk of internal bleeding. ”Children who go to school and start exercising should comply with the minimum protection standards for all children of this age. "If, for example, you use a bicycle, you must wear a helmet - specifies the specialist - if there is a bunk bed in the house, you must not sleep on the upper one, if you are skiing you must wear a helmet, if you skate you must wear protections, etc. Sports activities in which there is minimal physical contact (football, basketball, rugby, and the same martial arts such as judo and karate) do not represent an increased risk of internal bleeding at this age as the extent of the trauma is not of significant inertia To the rules of common sense, to be maintained in daily activities in this age group, regarding sport, it is necessary to take into account some correct and reasoned indications. “Sports activities have been divided into 3 traumatic risk ranges”, continues Spinelli. These sports are not recommended because they involve activities with a high risk of contact and repeated trauma (concussions): boxing, martial arts, motorcycling, rugby, diving. On the other hand, football, basketball, alpine skiing, artistic gymnastics, skating, horse riding are allowed with a medium risk of trauma. The sports authorized for low traumatic risk are: volleyball, golf, tennis, cycling, swimming. "In this age group the big limit is above all the impossibility of practicing low / medium risk sports at a competitive level, because so far it is the sports doctor who defines a person's suitability for competition - underlines the specialist -. In case of a low number of platelets (<20,000 / mm3) a doctor who is not a haematologist specialist tends to avoid granting this certificate. Therefore, in recent years we have been working together with the competent bodies so that a certificate of '4 hands' competitive sports activity (sports medicine doctor and haematologist) can be drawn up and recognized. In general, sports activities can be classified as: - high risk: rugby, sport climbing, hockey, combat sports. - moderate risk: football, basketball, gymnastics, skiing, horse riding, running, skating, tennis, volleyball, karate and other martial arts. - low risk: walking, jogging, swimming, weight lifting, cycling. Few think about it, but “platelets are also necessary for post-activity recovery - recalls Spinelli -. Those affected by ITP have a slower recovery than others. Pain, inflammation and stiffness are typical and persistent symptoms in the days following physical activity ". In the recovery phase, therefore, it is necessary “above all to rest - he concludes -. The use of painkillers is advisable only in case of great discomfort and must in any case be subject to the instructions of your doctor ".