A vitamin is an organic compound needed in small quantities that cannot be made in cells. In human nutrition , most vitamins function as coenzymes after modification; for example, all water-soluble vitamins are phosphorylated or are coupled to nucleotides when they are used in cells.  Nicotinamide adenine dinucleotide (NAD + ), a derivative of vitamin B 3 ( niacin ), is an important coenzyme that acts as a hydrogen acceptor. Hundreds of separate types of dehydrogenases remove electrons from their substrates and reduce NAD + into NADH. This reduced form of the coenzyme is then a substrate for any of the reductases in the cell that need to reduce their substrates.  Nicotinamide adenine dinucleotide exists in two related forms in the cell, NADH and NADPH. The NAD + /NADH form is more important in catabolic reactions, while NADP + /NADPH is used in anabolic reactions.
ITP is usually chronic in adults  and the probability of durable remission is 20–40 percent.  The male to female ratio in the adult group varies from 1: to in most age ranges (childhood cases are roughly equal for both genders) and the median age of adults at the diagnosis is 56–60.  The ratio between male and female adult cases tends to widen with age. In the United States, the adult chronic population is thought to be approximately 60,000—with women outnumbering men approximately 2 to 1, which has resulted in ITP being designated an orphan disease .