Immune thrombocytopenia, previously known as idiopathic thrombocytopenia (ITP), causes you to have a low platelet count. This may result in excessive bleeding inside and outside of your body. Bleeding associated with ITP isn’t typically life-threatening, but it can lead to serious complications.
Finding the right treatments can help stabilize and improve platelet counts and decrease the risk of internal and external bleeding. Effective treatments will reduce the symptoms of ITP, such as bruising and bleeding. They can also help provide you with more freedom to enjoy everyday activities without worry.
There’s no cure for ITP, so finding the right treatment is essential. It’s possible you’ll need more than one type of treatment to control your ITP. Talk to your doctor about the following options.
In ITP, your immune system attacks and destroys platelets, seeing them as foreign tissue. Low levels of blood platelets lead to your symptoms and related conditions.
Taking a thrombopoietin receptor antagonist can increase the platelet count. It helps your bone marrow make more platelets to counteract the losses. Examples include eltrombopag (Promacta) and romiplostim (Nplate).
These medications do pose a risk for side effects, such as:
- blood clots
For over 30 years, corticosteroids have been used in the treatment of ITP. In many cases, they’re still one of the first choices of treatment. They can be given orally or by vein.
Corticosteroids work by blocking the immune response of the body. This action is known as immunosuppression, and it decreases the number of harmful proteins made against platelets.
This medication is given for a period of time, then the dose is slowly lowered over the course of weeks. The length of treatment depends on the body’s response. Corticosteroid treatment may also be combined with other therapies.
Side effects associated with corticosteroids include:
- weight gain
- high blood sugar
- sleep difficulties
- fluid retention
Rituximab (Rituxan) is an antibody, a specialized protein, that links up with a specific immune cell in the body known as a B cell. Abnormally triggered B cells play a role in the destruction of platelets in ITP. When rituximab attaches to these abnormal B cells, it destroys them. This decreases the number of cells that are attacking the platelets.
There may be side effects with this medication that include:
- low blood pressure
- sore throat
Your doctor may prescribe intravenous immunoglobulin (IVIg) infusions if you don’t respond well to corticosteroids. These may also be used with corticosteroids or other treatments.
It isn’t exactly clear how IVIg works in ITP, but it’s known that its interaction with the immune system increases platelet counts. IVIg can be used before surgery or in other instances when you need to increase your platelet count right away.
IVIg helps prevent bleeding or treat potentially life-threatening bleeding when platelet counts are especially low. The effects of an infusion occur quickly and last up to four weeks. During that time, you may experience side effects such as:
- decreased blood pressure
- fevers and chills
Another type of immunoglobulin therapy is known as anti-D treatment, or anti-Rh immunoglobulin. This is an option for people with ITP who have a blood type that’s Rh-positive.
The immune proteins in this treatment are produced from screened and selected Rh-positive blood donors. Like IVIg therapy, anti-D treatment is most effective at raising extremely low platelet counts quickly in order to prevent complications. It can also be used in people who aren’t improving after removal of their spleen.
Side effects of this treatment can include:
- reactions to the infusion
- kidney injury
- blood in the urine
- other blood clotting complications
Not taking certain medications and supplements
Some herbal supplements and over-the-counter (OTC) and prescription medications can affect your platelet count by causing you to bleed more easily. These include:
- omega-3 fatty acids
- ginkgo biloba
- ibuprofen (Advil)
- selective serotonin reuptake inhibitors (SSRIs)
Depending on the severity of ITP, your doctor might recommend that you stop taking these medications. In some cases, cessation of these drugs and supplements is enough to control bleeding without any additional ITP treatments.
However, never stop taking any medication without your doctor’s approval.
When medications don’t work, your doctor might recommend a spleen removal, or splenectomy. Doctors typically only perform this procedure on adults who haven’t responded to other treatment options. Removing the spleen may help stop your body from attacking and destroying platelets so your platelet level can normalize.
However, a splenectomy isn’t for everyone with ITP. It’s effective about 65 to 70 percent of the time. Removing the spleen also puts you at risk for certain bacterial infections.
ITP can put you at an increased risk for infection, especially if you’ve had a splenectomy. Some symptoms that could indicate an infection include:
- body aches
If you develop a bacterial infection, antibiotics will be part of your treatment plan.
Diet and exercise can make you feel better as long as you’re careful about your choice of activities. It’s important to avoid activities and interactions that can cause injuries and increase bleeding. For example, your doctor may advise that you avoid certain contact sports. It’s also important to wear good shoes to prevent slips and falls.
Your doctor will likely recommend that you don’t drink alcohol. Drinking alcohol can slow down platelet and red blood cell production, which can become a dangerous combination with ITP.
What treatment is best for me?
The acute, short-lived, type of ITP is most common in children and typically resolves within six months. However, adults are more likely to have the chronic, lifelong, type of ITP and need ongoing treatment. A combination of medicines and lifestyle changes can help you manage ITP and feel better.
It’s also important to understand the related risks and side effects of each treatment. You may find that the side effects outweigh any potential benefits of your medication. You and your doctor will carefully weigh the pros and cons to help you find the best treatment option.