Immune thrombocytopenia (ITP) often requires lifelong treatment and monitoring in adults. You might already be taking medications to help boost your blood platelet levels. You may also be taking care to avoid excessive bleeding.

Despite taking your medications as directed, it’s possible that your current treatment plan isn’t working as well as it could. Your symptoms might come back following a remission. Or in some cases, your symptoms may worsen despite taking medications to increase platelet production. Learn more about the signs your ITP treatment plan isn’t effectively controlling your condition.

If it seems like you’re getting bruises a lot, you might have worsening of your ITP.

Normal bruising occurs when your tissue is damaged after an injury. Bruising easily from minor injuries or having bruises spontaneously appear can be a sign there is a worsening problem with your platelets. Having low platelets affects your clotting capabilities and increases bruising.

Larger bruises that spread under the skin are known as purpura.

Petechiae are small, scattered pinpoint bruises easily seen over small areas on the skin. They may also occur in the mouth. They’re often red but can have a purplish hue. These can be slightly raised and might be mistaken for dermatitis, a rash, or blemish. Petechiae are a sign of underlying bleeding.

Sometimes you can get a nosebleed from blowing your nose more than usual from allergies or a cold. However, if you’re having frequent nosebleeds, they could be caused by ITP. Some of these nosebleeds happen when you blow your nose, but other instances may occur for no apparent reason.

During a routine dental cleaning, your gums might bleed — even if you have good oral health. If there is bleeding, it might take longer to stop than normal. Your dentist might also see more extensive bruises around the inside of your mouth, known as purpura.

Alcohol affects the body in numerous ways. For example, chronic alcohol use can affect the bone marrow and reduce production of red blood cells and platelets. It can also be directly toxic to these cells. Alcohol can also affect how the platelets and other clotting factors work in your bloodstream.

If ITP is acting up, the effects from alcohol can be more noticeable. If your platelet count is already low, interfering with other clotting substances may cause unprovoked bleeding, leading to purpura or petechiae. Drinking alcohol can also make you feel more fatigued than usual.

In women, heavier periods can be a symptom of ITP. Your menstrual cycle may normalize with treatment. However, if your periods change, it could mean your treatment isn’t working. You may notice heavier periods alongside other symptoms, such as bruising and excessive bleeding. Your menstrual cycle may also be longer than usual.

Due to the inflammatory nature of ITP, your immune system is constantly under attack. Chronic inflammation affects a wide variety of functions within your immune system and your body as a whole. This makes you more susceptible to infections. Some symptoms of an infection include:

  • fever
  • chills
  • sweating
  • headaches
  • body aches
  • extreme fatigue
  • nausea
  • loss of appetite

People with ITP who’ve undergone a spleen removal (splenectomy) are at greatest risk for certain serious bacterial infections such sepsis, pneumonia, and meningitis.

Excessive fatigue is a symptom of undertreated ITP. You might feel wiped out during the day, even though you slept well the night before. You may also feel the need for frequent naps.

Another ITP-related risk factor for fatigue is excessive bleeding due to poor blood clotting abilities. When red blood cell counts become lower than normal, anemia develops. With anemia, there is poor oxygen delivery to the brain and other organs. This can lead to fatigue.

With chronic (lifelong) and recurring ITP, your doctor will likely order occasional blood tests to measure your platelet levels. If you aren’t responding to treatment as expected, you may need additional testing to check for viruses, other infections, other autoimmune conditions, blood cancers, and other blood cell conditions. You may also need a bone marrow biopsy if you blood counts can’t recover or if you’re experiencing new or worsening symptoms of ITP.

Normal platelet counts range between 150,000 and 450,000 platelets per microliter (mcL) of blood. People with ITP have counts below 100,000 per mcL. A measurement of 20,000 or fewer platelets per mcL might mean you need a transfusion of blood products or immunoglobulin therapy. This is considered a life-threatening emergency. Platelet levels this low can lead to spontaneous bleeding in the brain and other organs, so emergency correction is required.

The goal of taking medications for ITP is to feel better. The side effects associated with your medicines can be worse than the initial ITP symptoms, however. So you might be wondering whether taking your medicine is worth it.

It’s important you keep taking your prescribed ITP medications until you talk to your doctor. Also, talk to your doctor if you’re experiencing any of the following symptoms:

  • nausea
  • vomiting
  • rashes
  • excessive fatigue
  • flu-like symptoms, such as fever and sore throat
  • chest pain
  • shortness of breath
  • diarrhea

There’s no cure for ITP, so symptomatic cases require ongoing treatment. Effective treatment can help prevent excessive bleeding and related complications, such as bleeding in the brain or other organs.

However, treatment can be just as complex as the condition. There’s no one treatment measure that works for ITP. You may need to try several options before you find what works. Your doctor might prescribe multiple treatments depending on how severe your condition is.

The key to effective ITP treatment is to stay in touch with your doctor and let them know if you think your current medications aren’t working.