Immune thrombocytopenia, previously known as idiopathic thrombocytopenic purpura (ITP), causes you to have a low platelet count. This may result in excessive bleeding inside and outside your body.
Finding the right treatments can help stabilize and improve platelet counts and decrease the chances 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.
Talk with your doctor about the following treatment options.
A variety of treatments are available to treat ITP:
Corticosteroids have been used as a first-line treatment for ITP for more than 30 years, according to available research from 2016. They can be given orally or intravenously.
Two corticosteroids that may be prescribed for ITP are high dose dexamethasone and oral prednisone.
According to 2019 guidelines from the American Society of Hematology (ASH), adults newly diagnosed with ITP should be treated with prednisone for no more than 6 weeks.
Most children with ITP don’t require treatment. However, corticosteroids are used as first-line treatments for children who do require treatment.
Corticosteroids work by blocking your body’s immune response. This action is known as immunosuppression, and it decreases the number of harmful proteins that can attach themselves to your 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 your body’s response. Corticosteroid treatment may also be combined with other therapies.
Side effects associated with corticosteroids include:
- increased risk of infection
- weight gain
- high blood sugar
- sleep difficulties
- fluid retention
Thrombopoietin receptor antagonists
With ITP, your immune system attacks and destroys platelets because it sees them as foreign tissue. In turn, low levels of blood platelets lead to your symptoms and related conditions.
Taking a thrombopoietin receptor antagonist — a type of medication — can increase your platelet count. It helps your bone marrow make more platelets to counteract the losses.
Examples include eltrombopag (Promacta) and romiplostim (Nplate).
These medications do come with the potential for side effects, such as:
- blood clots
Rituximab (Rituxan) is an antibody, or specialized protein, that links up with a specific immune cell in your 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 attacking your platelets.
Side effects of this medication may include:
- body aches
Your doctor may prescribe intravenous immunoglobulin (IVIG) infusions if you don’t respond well to corticosteroids. These infusions may also be used with corticosteroids or other treatments.
It isn’t exactly clear how IVIG works in ITP, but experts have established that its interaction with your immune system increases platelet counts, according to a 2017 research review.
IVIG can be used before surgery or in other instances when you need to increase your platelet count right away.
It helps prevent bleeding or can treat potentially life threatening bleeding when platelet counts are especially low.
The effects of an infusion occur quickly and last up to 4 weeks. During that time, you may experience side effects, such as:
- decreased blood pressure
- fevers and chills
There’s another type of immunoglobulin therapy 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 the 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
Avoiding certain medications and supplements
Some herbal supplements, over-the-counter medications, and prescription medications can cause you to bleed more easily, which affects your platelet count.
- ibuprofen (Advil, Motrin)
- omega-3 fatty acids
- ginkgo biloba
- selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac, Sarafem) and sertraline (Zoloft)
- warfarin (Coumadin)
Depending on the severity of your 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. You won’t need 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, called a splenectomy. Doctors typically perform this procedure only on adults who haven’t responded to other treatment options.
Removing your spleen may help stop your body from attacking and destroying platelets, so your platelet level can normalize.
However, splenectomy isn’t for everyone with ITP. It’s effective about 65 to 70 percent of the time. Removing your 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
- sore throat
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 is dangerous for a person with ITP.
If you have ITP, your gums may bleed or blisters may form in your mouth after you undergo routine dental treatments, such as cleanings. In extreme cases, everyday brushing and flossing may cause bleeding gums too.
For years, researchers believed that people with ITP shouldn’t undergo dental procedures if their platelet count was below a certain threshold — typically 50,000 platelets per microliter (mcl). Platelet transfusions were recommended as a way to help prevent complications from excess bleeding.
In addition, receiving a platelet transfusion didn’t help to reduce a person’s chances of postoperative bleeding.
ITP affects 1 in 1,000 to 1 in 10,000 of all pregnancies. If you’re pregnant, treatment may not be necessary unless your platelet count drops below 20,000 to 30,000 platelets per mcl.
The preferred treatment for pregnant women is daily oral prednisone, according to a 2017 research review.
However, in the long term, heavy use of corticosteroids may result in complications, such as preterm birth or gestational diabetes. It may also slightly increase your risk of having a baby born with a cleft palate.
If corticosteroids aren’t effective or tolerated well, you may be prescribed IVIG.
Splenectomies are safe through the second trimester, but they’re rarely necessary.
There’s no cure for ITP, so finding the right treatment is essential.
Treatment is typically successful at raising platelet counts. However, it’s possible you’ll need more than one type of medication to help manage your condition.
The acute, short-lived type of ITP is most common in children and typically resolves itself within 6 months.
However, adults are more likely to have the chronic, lifelong type of ITP that needs ongoing treatment. A combination of medications and lifestyle changes can help you feel better and manage your ITP.
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.
Carefully weigh the pros and cons with your doctor. They can help you find the best treatment option for you.
Can ITP be cured completely?
In children, ITP typically goes away within
In adults, around 1 in 10 people with ITP experience remission, often within 6 months of a diagnosis. Those who don’t see remission can usually manage their platelet levels with treatment.
What foods should you avoid with ITP?
Some foods can interfere with blood clotting if you eat them in large amounts. If you have ITP, speak with a doctor before significantly increasing your intake of blueberries, ginseng, garlic, tomatoes, and drinks containing quinine, such as tonic water and bitter lemon.
The Platelet Disorder Support Association also encourages people to eat plenty of whole foods and fresh fruits and vegetables and to limit their intake of processed foods and alcohol, to benefit their overall health.
Is ITP life threatening?
The most serious complication of ITP is a hemorrhage between the skull and the brain (intracranial hemorrhage), a life threatening type of stroke. But fewer than
ITP is a condition that causes a low platelet count. It can lead to easy bruising and bleeding.
Treatment options include corticosteroids, thrombopoietin receptor antagonists, antibody therapy, and immunoglobulin infusions. In some cases, a person may need surgery to remove the spleen.
A doctor can advise on the best treatment option to manage ITP and prevent complications.