Immune Thrombocytopenia Purpura (ITP)

Immune Thrombocytopenia (ITP)

Immune thrombocytopenia or ITP is a blood disorder in which the number of platelets in the blood is decreased to low levels. This can be unsafe 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 these 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 (stool)
  • Too much bleeding with injury
  • Drawn-out menstrual bleeding
  • Internal bleeding (very rare)

Incidence of ITP

ITP can occur in both children and adults.

  • Acute ITP is the most common form of the disease. Acute ITP occurs all of the sudden, sometimes after a virus, and the symptoms most often go away in less than three 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 said to be chronic when the low platelet levels last longer than 12 months. Chronic ITP affects more adults and teens than young children, and more females than males. There is no way to predict who will develop chronic ITP.
  • Rarely, ITP can come back after having had a normal platelet count for months or years (1 percent to 4 percent of children).

Causes of ITP

The human body's immune system fights off infection. With ITP, the immune system makes antibodies by mistake 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. The actual cause of ITP is not known.

Diagnosis of ITP

Blood and urine tests, along with a full exam, are used to diagnose ITP. The number of platelets within the blood is looked at closely. If the diagnosis of ITP is not clear, a bone marrow biopsy may be done, but this is most often not required.

Treatment for ITP

Treatment is not always needed for ITP. Treatment for ITP can vary based on the patient's age, medical history and how severe bleeding symptoms are. Not all children with ITP need treatment. In these cases, the treatment of choice is watching platelet counts and avoiding doing things that may cause injury or bleeding. This allows the body time to correct the disorder.

First-line treatment options may include:

  • Corticosteroids given by mouth. Corticosteroids (such as Prednisone) decrease the amount of platelets being destroyed. This helps to prevent bleeding. Common side effects may include increased appetite, weight gain, high blood pressure, acne, upset stomach and irritability.
  • 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 (such as, A+, B+, AB+, O+). Common side effects may include headache, chills and fever, anemia.

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

  • 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.
  • Rituximab (Rituxan), given intravenously. Rituxan reduces the destruction of platelets. Common side effects may include fever, chills, weakness, nausea (upset stomach), 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 often in older children with chronic ITP.

Living with ITP

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

Call Your Child's Doctor If:

  • A significant increase in bruises or petechiae rash
  • Bleeding that will not stop within five minutes
  • Headache, lethargy (very tired), irritability
  • Vomits blood or has blood in the urine or stool
  • Bumps their head or abdomen
  • Bleeding in the mouth when brushing their teeth
  • Problems taking or refusing to take prescribed medicines

Last Updated 01/2019