Introduction

Idiopathic thrombocytopenic purpura (ITP) is a particular form of thrombocytopenia marked by a reduced platelet count without changes in bone marrow that can be detected or other causes.^[1] The fall in platelets is due to impaired synthesis or augmented peripheral destruction.^[2] Platelet destruction in most instances is result of antiplatelet membrane glycoprotein antibodies.^[3] Primary ITP is found without known predisposing factors or underlying causes, while secondary ITP is seen with IgG-related autoimmune diseases like systemic lupus erythematosus, viral infections (especially in children), lymphoproliferative disorders, neoplasms, and other similar diseases.^[4] In children, cases of ITP are particularly secondary to febrile illnesses, usually following a viral illness.^[5] Various mechanisms have been associated with its pathogenesis, such as production of platelets promoting viral antigens, formation of antiviral antibodies that cross-react with antigens, formation of antibodies by IgG epitope spreading, and role of immune-binding complexes.^[6] Megakaryocytes, particularly precursor cells for platelets, have a role to play in controlling intravascular coagulation, microangiopathic syndromes, and hemophagocytosis. These mechanisms can modify platelet surface, causing enhanced clearance from circulation.^[7] Fatigue is a prevalent but frequently underappreciated symptom in idiopathic thrombocytopenia (ITP), chiefly due to decreased platelet numbers.^[8] Patients often neglect this fatigue, whereas doctors focus on controlling bleeding, ignoring other areas like emotional distress and functional capacity.^[9] Fatigue profoundly impacts health-related quality of life (HRQoL), both reflecting mental and physical health.^[10] In chronic ITP, extreme bleeding requires prompt intervention; however, though platelet numbers rise with therapy, fatigue remains. Early intervention in adults can help prevent disease progression. ^[11]

Fatigue in immune thrombocytopenia (ITP) is mainly caused by chronic bleeding, which leads to iron deficiency and anemia.^[12] Although treatments like corticosteroids, immunoglobulin, and anti-D are effective in enhancing platelet counts, they fail to restore blood volume or restore iron stores instantaneously, and hence fatigue improves gradually.^[13]

Also, Yoga gives immune-modulating and anti-inflammatory actions by inhibiting inflammatory mediators associated with immune thrombocytopenia, in addition to reducing oxidative stress and facilitating endothelial function.^[24] Psychologically, Yoga significantly increases emotional health by reducing anxiety, depression, and emotional distress connected with chronic disease. It also promotes resilience, self-efficacy, and quality of life overall through mindfulness activities, making it a holistic intervention for both physical and mental health.^[25]

Discussion

Studies on direct effect of Yoga on platelet count in ITP are few; however, there is evidence that Yoga can enhance immune modulation and decrease systemic inflammation, potentially leading to enhanced platelet stability.^[26] Some Yoga postures and breathing techniques are thought to improve blood circulation and facilitate hematopoietic function, which may be beneficial in low platelet counts.^[27] Stress is also a recognized precipitating factor for autoimmune diseases, including ITP, as chronic stress leads to glucocorticoid release, e.g., cortisol, which can inhibit immune function and lead to disease progression.^[28] Yoga has been extensively researched to reduce cortisol levels and stimulate parasympathetic nervous system, thus reducing stress-induced immune dysregulation.^[29] Mindfulness-based stress reduction (MBSR) courses involving Yoga have shown marked benefits in reducing psychological distress in patients with chronic illness.^[30] ITP patients also commonly present with fatigue, anxiety, and reduced physical activity due to risk of bleeding, with fatigue being particularly disabling due to chronic low platelet counts, prolonged bleeding, and iron deficiency anemia.^[31] Gentle Asanas, Pranayama, and meditation have been found to increase energy levels, emotional status, and quality of life.^[27] Yoga has also been associated with elevated serotonin & dopamine levels, enhancing mood & motivation, thus enabling individuals to cope with psychological impact of ITP.^[26] In addition, Yoga practitioners tend to have improved sleep quality, which may counteract chronic fatigue, which is a common complaint in ITP patients. In addition to its psychological effects, Yoga improves cardiovascular & musculoskeletal function, which are commonly impaired in patients with chronic illness.