Immune thrombocytopenia, or ITP, is an immune disorder where blood doesn’t clot quickly because the body doesn’t have enough platelets.
As a result, ITP can lead to excessive bruising and bleeding internally, as well as on and under the skin.
People with ITP often have many purple bruises called purpura on their skin or inside their mouth because of their low platelet count. These bruises may also appear as pinpoint-sized red or purple dots, kind of like a rash, on the skin, which is called petechiae.
ITP used to be called Idiopathic thrombocytopenic purpura, but the name has changed. The condition is no longer idiopathic (which means there’s no known cause) because researchers now know the condition is autoimmune, and “purpura” was dropped from the name because around one-third of newly diagnosed patients have no bleeding.
The condition affects approximately 50 to 150 people per million, and it can occur in anyone at any age, though it’s more prevalent in adults after the age of 60.
About 40 percent of all cases affect children, though it seems to develop most frequently in kids between the ages of 2 and 4. This is especially true after they’ve been sick with another viral illness, like chickenpox, mumps, and measles.
The two main types of ITP:
- Acute ITP. This type is short term, lasting less than 6 months. It’s the most common form of the disorder in children.
- Chronic ITP: This long-term form lasts 6 months or longer and is most commonly seen in adults, though it can affect anyone.
Platelets are created in your bone marrow. They help blood cells stick to each other and proteins in order to seal and heal wounds and cuts. But when your platelet levels are low, as it is with ITP, it takes longer for wounds to stop bleeding and heal.
Platelet levels are low with ITP because your immune system’s antibodies attack and destroy platelets if you have this immune disorder.
ITP isn’t contagious and can’t be passed from one person to another. But it can be classified as primary, meaning it occurs on its own, or it can be secondary, which means that another condition triggers it.
Possible triggers for secondary ITP include
- other autoimmune diseases
- chronic infections
- certain medications, like ibuprofen or asprin
- certain types of cancer
ITP has been called “idiopathic,” which means it has no known cause. This is because the condition is not hereditary, and there aren’t any known predispositions for primary ITP.
ITP doesn’t always cause noticeable symptoms. Someone with ITP can also be asymptomatic for long periods of time and not have any symptoms until they have an episode.
If there are symptoms, the most common ones include:
- easy bruising, even if you don’t remember bumping something
- pinpoint-sized petechiae, or reddish-purple dots that almost look like a rash on your skin, usually on your lower legs
- spontaneous nosebleeds
- gum bleeding
- cuts that take a long time to stop bleeding or scab over
- blood in the urine
- blood in the stool
- abnormally heavy menstruation
- profuse bleeding during surgery
To be diagnosed with ITP, your doctor will start by performing a complete physical exam. They’ll ask you about your medical history and the medications you’re taking.
Your doctor will also order blood tests that could measure:
- a complete blood count (CBC)
- electrolyte levels
- liver and kidney function
- platelet antibodies
Your doctor will also request a blood smear. During this procedure, some of your blood is placed on a glass slide and viewed under a microscope to verify the number and appearance of platelets seen in the complete blood count.
If you have a low platelet count, your doctor may also order abone marrow test. If your bone marrow is abnormal, your low platelet count is likely caused by another disease rather than ITP.
But if you have ITP, your bone marrow will be normal. This is because your platelets are destroyed in the bloodstream and spleen after they leave the bone marrow, not in your bone marrow itself.
Your doctor will choose your treatment based on:
- your total number of platelets
- how often you bleed
- how much you bleed
In some cases, treatment isn’t needed. For example, children that develop the acute form of ITP usually recover within 6 months or less without treatment.
Adults with less severe cases of ITP may also not require treatment. But your doctor will still want to monitor your platelet and red blood cell count to make sure you don’t need treatment in the future.
Platelet counts that become too low put you at risk for spontaneous bleeding in the brain or other organs, while low red blood cell counts can be a sign of internal bleeding.
If you or your child requires treatment, your doctor will likely prescribe medications as the first course of treatment. The most common medications used to treat ITP include:
Your doctor may prescribe a corticosteroid, like prednisone (Rayos), which can increase your platelet count by decreasing the activity of your immune system.
Intravenous immunoglobulin (IVIg)
If your bleeding has reached a critical level or you’re going to have surgery and need to increase your platelet count quickly, you may be given intravenous immunoglobulin (IVIg).
This is for people who have Rh-positive blood. Like IVIg therapy, it can quickly increase the platelet count, and it may work even faster than IVIg. But it can have serious side effects, so individuals should be careful with this treatment.
This antibody therapy targets the immune cells responsible for producing the proteins that attack platelets. When this medication binds to those immune cells, known as B cells, they’re destroyed. This means there are fewer cells available to make the proteins that attack platelets. But it’s unclear if this treatment has long-term benefits.
Thrombopoietin receptor agonists
Thrombopoietin receptor agonists, including romiplostim (Nplate) and eltrombopag (Promacta), help prevent bruising and bleeding by causing your bone marrow to produce more platelets. Both of these medications have been approved by the Food and Drug Administration (FDA) for the treatment of low platelet counts due to chronic ITP.
General immunosuppressants are generally only prescribed if the other drugs listed above don’t improve your symptoms and you have a severe case of ITP.
Immunosuppressants inhibit the overall activity of your immune system, not just the specific components of the immune system related to ITP. As a result, they can have significant side effects.
These medications are generally avoided today.
Helicobacter pylori, which is the bacteria that causes most peptic ulcers, has been associated with ITP in some people. So if other medications don’t work, some doctors may consider prescribing antibiotic therapy to eliminate H. pylori because that has been shown to help increase platelet counts in some people.
But more research is still needed on the efficacy of this strategy, so it’s not standard treatment.
If you have severe ITP and medication doesn’t improve your symptoms or platelet count, your doctor may advise surgery to remove your spleen. This is called a splenectomy.
Splenectomy isn’t usually performed in children because of the high rate of spontaneous remission or unexpected improvement. Having a splenectomy also increases the risk of certain bacterial infections in the future.
Severe or widespread ITP requires emergency treatment. This usually includes transfusions of concentrated platelets and intravenous administration of a corticosteroid like methylprednisolone (Medrol), IVIg, or anti-D treatments.
Your doctor may also advise you to make some lifestyle changes, including:
- avoiding certain over-the-counter drugs that can affect platelet function, like aspirin, ibuprofen (Advil, Motrin), and the blood-thinning medication warfarin (Coumadin)
- limiting your intake of alcohol (consuming alcohol can adversely affect blood clotting)
- choosing low-impact activities instead of competitive sports or other high-impact activities to decrease your risk of injury and bleeding
Treatment for pregnant people with ITP depends on the platelet count. If you have a mild case of ITP, you probably won’t need any treatment other than careful monitoring and regular blood tests.
But if you have an extremely low platelet count and it’s late in the pregnancy, you’re more likely to experience serious, heavy bleeding during and after delivery. In these cases, your doctor will work with you to determine a treatment plan that will help maintain a safe platelet count without adversely affecting your baby.
If you experience ITP along with other serious conditions of pregnancy, like preeclampsia, you’ll need treatment as well.
Although most babies born to mothers with ITP aren’t affected by the disorder, some are born with or develop a low platelet count soon after birth. Treatment may be necessary for babies with very low platelet counts.
The most dangerous complication of ITP is bleeding, especially bleeding into the brain, which can be fatal. But serious bleeding is rare.
In fact, some of the treatments for ITP can have more risks than the disease itself. For example, the long-term use of corticosteroids can cause serious side effects, including:
Surgery to remove the spleen increases your risk of bacterial infections and the risk of becoming seriously ill if you get an infection. If you have a splenectomy, it’s important to watch for any symptoms of infection and report them to your doctor promptly.
For most people with ITP, the condition isn’t serious or life-threatening. For example, acute ITP in children often resolves within 6 months or less without treatment.
Chronic ITP, though, can last for many years. Still, people can live for many decades with the disease, even those with severe cases. Many people with ITP are able to manage their condition safely without any long-term complications or a decreased life span.