Immune Thrombocytopenia Purpura (ITP)

Immune thrombocytopenia purpura or ITP is a blood disorder in which the number of platelets in the blood is decreased to low levels.  This can be dangerous because people depend on platelets to help stop bleeding. Platelets act like plugs in stopping the bleeding process. When a person has ITP, they may not have enough platelets to come together and plug up the source of bleeding.

This can cause the following symptoms:

  • Easy bruising
  • Nose bleeds
  • Bleeding from small blood vessels that cause round red / purple pinpoint spots on the skin called petechiae
  • Bleeding gums and small red / purple pinpoint spots in the mouth, or blood blisters in the mouth
  • Blood in urine and bowel movements
  • Excessive bleeding with injuries
  • Prolonged menstrual bleeding  
  • Internal bleeding (very rare)

ITP can occur in both children and adults.

  • Acute ITP is the most common form of the disease. Acute ITP occurs suddenly, sometimes following a virus, and the symptoms usually disappear in less than six months.
  • Persistent ITP can last longer than three months but less than one year.
  • Chronic ITP can happen at any age and tends to last longer than acute ITP. ITP is considered to be chronic when the low platelet levels last longer than 12 months. Chronic ITP affects more adults and teenagers than young children, and more females than males. There is no way to predict who will develop chronic ITP.
  • Rarely, ITP can recur after having had a normal platelet count for months or years (1 percent to 4 percent of children).

The human body's immune system fights off infection. With ITP, the immune system mistakenly makes antibodies that destroy the patient's own blood platelets. This attack causes the platelets to be low in a person with ITP. Doctors do not know what causes the body to destroy its own platelets; therefore the actual cause of ITP is unknown.

Blood and urine tests, along with a complete physical exam, are used to diagnose ITP. Special attention is given to the number of platelets within the blood. If the diagnosis of ITP is not clear, a bone marrow biopsy may be done, but this is usually not required. 

Treatment is not always needed for ITP. Treatment for ITP can vary depending on the patient's age, medical history and severity of bleeding symptoms. Not all children with ITP require treatment. In these cases, monitoring platelet counts and avoiding activities that may cause injury or bleeding is the treatment of choice. This allows the body time to correct the disorder.

First-line treatment options may include:

  • Immune globulin (IVIG), given intravenously. IVIG slows down the destruction of platelets. Common side effects may include fever, chills, headache, light-headedness, flushing, itching, and a change in blood pressure.
  • Anti-D IgG or WinRho, given intravenously. WinRho helps to protect platelets and is only an option for patients with an Rh-positive blood type (for example, A+, B+, AB+, O+). Common side effects may include headache, chills and fever, anemia.
  • Corticosteroids, given by mouth. Corticosteroids (such as Prednisone) decrease the amount of platelets being destroyed which helps to prevent bleeding. Common side effects may include increased appetite, weight gain, high blood pressure, acne, upset stomach and irritability.

Second-line treatment (if other treatments are needed):

  • Rituximab (Rituxan), given intravenously. Rituxan reduces the destruction of platelets. Common side effects may include fever, chills, weakness, nausea, headaches and infections. 
  • Splenectomy. The location of platelet destruction is in the spleen. As a result, the spleen may need to be removed. This treatment option occurs more frequently in older children with chronic ITP.
  • N-Plate (romiplostim), given subcutaneously. N-Plate increases the number of platelets the body makes to overcome the platelet antibodies.
  • Promacta (Eltrombopag), given by mouth. Promacta increases the number of platelets the body makes to overcome the platelet antibodies. 

When platelet counts are especially low, people who have ITP need to avoid contact sports, rough play and medications containing aspirin, naproxen or ibuprofen (NSAIDS). Children may need safe environments such as padded cribs and helmets to protect their head. Avoiding salty foods is important if the patient is taking steroids.

  • A significant increase in bruises or petechiae rash
  • Bleeding that will not stop within five minutes
  • Headache, lethargy, irritability  
  • Vomits blood or has blood in the urine or stool
  • Bumps his/her head or abdomen
  • Bleeding in the mouth when brushing his/her teeth
  • Difficulty taking or refusing to take medications prescribed

Last Updated 03/2016