Platelet Disorders Immune Thrombocytopenia (ITP)

---

Immune thrombocytopenia (ITP) is a type of platelet disorder. In ITP, your blood does not clot as it should, because you have a low platelet count. Platelets are tiny blood cells that are made in the bone marrow. When you are injured, platelets stick together to form a plug that seals your wound. This plug is called a blood clot. When you have a low platelet count, you may have trouble stopping bleeding.

ITP can be acute (short-term) or chronic (long-term). Acute ITP often lasts less than 6 months. It mainly occurs in children — both boys and girls — and is the most common type of ITP. Chronic ITP lasts 6 months or longer and mostly affects adults. However, some teens and children do get this type of ITP. Chronic ITP affects women two to three times more often than it affects men.

ITP may not cause any symptoms. However, ITP can cause bleeding that is hard to stop. This bleeding can be inside your body, underneath your skin, or from your skin.

Signs of bleeding may include:

• Petechiae, which are small, flat red spots under the skin caused by blood leaking from blood vessels
• Purpura, which is bleeding in your skin that can cause red, purple, or brownish- yellow spots
• Clotted or partially clotted blood under your skin (called a hematoma) that looks or feels like a lump
• Nosebleeds or bleeding from your gums
• Blood in your urine or stool
• Heavy menstrual bleeding
• Extreme tiredness

To diagnose ITP, your provider will ask about your medical and family history. They will also ask about your symptoms and do a physical exam to look for signs of bleeding.

Your provider may order one or more of the following blood tests.

• Complete blood count (CBC): This test measures your platelet count and the number of other blood cells in your blood.
• Blood smear: For this test, some of your blood is put on a slide. A microscope is used to look at your platelets.
• Bone marrow tests: These tests check whether your bone marrow is healthy. You may need this test to confirm that you have ITP and not another platelet disorder, especially if your treatment is not working.

You also may have a blood test to check for the antibodies that attack platelets.

If you’re at risk for HIV, hepatitis C, or Heliobacter pylori, your provider may screen you for these infections, which might be linked to ITP.

ITP is caused by problems with your immune system . Normally, your immune system helps your body fight off infections and diseases. In ITP, however, your immune system attacks and destroys your body’s platelets by mistake. You may also make fewer platelets. Why this happens is not known.

Some things that can raise your risk of ITP include:  

• Antibiotics, antiviral medicines, or medicines to treat inflammation
• Viral or bacterial infections, which can trigger your immune system to start destroying your platelets
• Vaccines, such as the measles-mumps-rubella (MMR) vaccine, which, rarely, can raise the risk of ITP, especially in children

For most children and adults, ITP is not a serious condition. Acute ITP in children often goes away on its own within a few weeks or months and does not return. For a small number of children, ITP does not go away on its own, and the child may need treatment.

Chronic ITP varies from person to person and can last for many years. Even people who have serious types of chronic ITP can live for decades. Most people who have chronic ITP can stop treatment at some point and maintain a safe platelet count.

Treatment depends on your platelet count and whether you have any symptoms. In mild cases, you may not need any treatment, and your provider will monitor your condition to make sure that your platelet count does not become too low. If you need treatment, your treatment plan may include medicines and procedures. If your ITP was caused by an infection, treating the infection may help increase your platelet count and lower your risk of bleeding problems.

Medicines

Medicines often are used as the first treatment for both children and adults.

Corticosteroids , such as prednisone and dexamethasone, are commonly used to treat ITP. These medicines help increase your platelet count. However, steroids have many side effects. Some people relapse (get worse) when treatment ends. 

Other medicines used to raise the platelet count include:  

• Eltrombopag
• Immune globulin
• Rituximab
• Romiplostim

Removal of your spleen (splenectomy)

Doctors can surgically remove your spleen if necessary. The spleen is an organ in your upper left abdomen. It makes antibodies that help fight infections. In ITP, these antibodies destroy platelets by mistake.

Removing your spleen may raise your risk of infections. Before you have the surgery, your doctor may give you vaccines to help prevent infections. They will explain what steps you can take to help avoid infections and what symptoms to watch for.

Platelet transfusions

Some people who have ITP with serious bleeding may need to have a platelet transfusion. This is done in a hospital. Some people will need platelet transfusions before having surgery.

For a platelet transfusion, donor platelets from a blood bank are injected into your bloodstream. This increases your platelet count for a short time. Learn more about platelet transfusions.

Without proper treatment, ITP can cause serious bleeding and pregnancy complications. Learn how to manage ITP to help avoid complications.