Immune thrombocytopenia (ITP) is an autoimmune disease that causes low platelet levels.
Platelets are cell fragments in your blood that help it clot when you injure yourself. Having too few platelets can make you bruise or bleed more easily than usual.
Sometimes ITP can come back after treatment. Here are answers to common questions about when ITP comes back.
There are three types of ITP:
- acute ITP
- persistent ITP
- chronic ITP
Depending on the type of ITP you have, it can come back.
Acute ITP, which is also called newly onset ITP, is the most common form of the condition. It comes on suddenly, with symptoms lasting for fewer than 3 months. This type usually:
- occurs in younger kids
- doesn’t require treatment
- doesn’t come back
About 80 percent of kids who are newly diagnosed with ITP will have a case that resolves within 12 months, according to the National Organization for Rare Disorders. More than 50 percent of newly-diagnosed adults will go on to have chronic ITP, the group estimates.
Persistent ITP lasts for between 3 to 12 months. It usually doesn’t go into remission on its own and doesn’t always go away after treatment.
Chronic ITP lasts for at least 12 months. It’s more common in adults and can come back frequently. Symptoms start more gradually and can last up to several years.
Chronic ITP isn’t curable. With chronic ITP, you’ll have remission periods when your symptoms improve for months or even years.
But eventually chronic ITP symptoms recur. Some people with chronic ITP have many recurrences.
ITP is very unpredictable. There’s no way to know for sure whether the disease will come back or when it might return. That’s why it’s important to stay alert for new symptoms.
Splenectomy is surgery to remove your spleen.
Your spleen is part of your immune system. It removes platelets from your blood, and it produces antibodies that destroy your platelets.
In theory, removing your spleen should increase your platelet levels. But because your liver also removes platelets from your blood, splenectomy doesn’t always raise platelet levels.
About 10 to 15 percent of people with ITP don’t respond to splenectomy, according to the Platelet Disorder Support Association. Between 30 percent and 35 percent of people who do respond eventually relapse.
ITP is usually treated by a hematologist, a specialist in blood diseases. Your hematologist will likely schedule regular follow-up visits to check for recurrences.
Some people with chronic ITP don’t have any symptoms, even when their platelet count is low. If you do have recurrence symptoms, they may be very similar to the ones you had when you were first diagnosed.
Between doctor’s office visits, watch for the following symptoms:
- easy or excessive bruising that doesn’t have an obvious cause
- a rash-like cluster of tiny red dots under your skin, called petechiae, which often appear on your lower legs
- bleeding around your gums
- frequent nosebleeds
- blood blisters inside your mouth
- heavy or long menstrual periods
- blood in your feces or urine
- a severe headache or blurred vision, which can be caused by bleeding in the brain
Call your doctor right away if you have any of these symptoms. It’s important to get treated quickly to prevent serious bleeding.
To confirm whether you’re having a recurrence, your doctor will do a blood test to check your platelets. You may need other blood tests to confirm whether your ITP has returned.
Treatments for ITP include medications to increase your platelet count and surgery to remove your spleen (splenectomy). These therapies can stop bleeding, bruising, and other ITP symptoms.
If your symptoms are mild, your doctor may wait and observe you before offering treatment.
If your platelet levels are very low or if you’re experiencing severe symptoms, your doctor may recommend starting treatment right away.
A few different medicines treat ITP. These prescription drugs work by either stopping your immune system from destroying platelets or by increasing the number of platelets your bone marrow produces.
- Corticosteroids (steroids). These medications include prednisone and dexamethasone. They prevent your immune system from attacking and destroying your platelets. Some people relapse as soon as they stop taking steroids. These prescription drugs can also cause side effects including:
- weight gain
- high blood pressure
- Intravenous immunoglobulin (IVIG). This can raise your platelet counts for a short period of time. Your doctor may give you an IV injection of this medication if steroids don’t work. It can be repeated for longer-lasting results.
- Anti-RhoD (WinRho). This is another IV injection that temporarily increases platelet counts. It may be used instead of IVIG.
- Antibiotics. These medications can help clear up an infection if bacteria caused ITP. This helps bring your platelet count back up to normal.
If steroids and antibody treatments don’t relieve your symptoms, your doctor may try a second- or third-line therapy, such as:
- Rituximab (Rituxan, Truxima). This is a monoclonal antibody that stops your immune cells from destroying your platelets. But it’s important to note that this medication can decrease the effectiveness of vaccines. And though it’s frequently prescribed, it hasn’t been approved by the FDA to treat ITP.
- Platelet growth factors. These stimulate your bone marrow to make new platelets; however, they can increase risk of blood clots. Options include:
- avatrombopag (Doptelet)
- eltrombopag (Promacta, Revolade)
- romiplostim (Nplate)
- Fostamatinib disodium hexahydrate (Tavalisse). This is a drug that targets the spleen tyrosine kinase (SYK)enzyme in your body. It may slow the destruction of platelets in people with chronic ITP.
Splenectomy, or surgery to remove your spleen, may be necessary if medications don’t work. Your spleen makes antibodies that destroy platelets. Splenectomy helps to increase the number of platelets in your body.
While splenectomy can boost your platelet count, it can cause side effects. Your spleen is an important part of your immune system. Without it, your body may be less able to fight infections.
It’s rare for people to die from ITP. Most people get better within 5 years of starting treatment.
ITP symptoms can eventually come back. You may require treatments to manage ITP for the rest of your life.
Acute ITP usually goes away on its own without treatment. But chronic ITP can come back after you treat it, sometimes frequently.
The doctor who treats your ITP will monitor you for signs that your disease has come back. If your platelet count drops or you develop severe ITP symptoms, your doctor may recommend undergoing treatment again.
Medications such as steroids and platelet growth factors stop your immune system from destroying your platelets or help your body make new platelets.
Surgery is another option to raise your platelet count and relieve ITP symptoms like bruising and bleeding.
Talk with your doctor about the best treatment for you based on your age, your health, and the extent of the condition.