Definition

What is idiopathic thrombocytopenic purpura (ITP)?

Idiopathic thrombocytopenic purpura (ITP) is a disorder in which the blood doesn’t clot normally. This can cause excessive bruising and bleeding. An unusually low level of platelets, or “thrombocytes,” in the blood, causes ITP. ITP is also called immune thrombocytopenic purpura.

Platelets are produced in the bone marrow. They help stop bleeding by clumping together to form a clot that seals cuts or small tears in blood vessel walls. If your blood doesn’t have enough platelets, it’s slow to clot. Internal bleeding or bleeding on or under the skin can result.

People with ITP often have many purple bruises called purpura on the skin or mucous membranes inside the mouth. These bruises may also appear as pinpoint-sized red or purple dots on the skin called petechiae. Petechiae may look like a rash.

How common is idiopathic thrombocytopenic purpura (ITP)?

ITP can occur in both children and adults. According to the Mayo Clinic, it’s more common in women than men. Children are more likely to develop this condition after a viral illness, such as the mumps or measles. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of idiopathic thrombocytopenic purpura (ITP)?

Idiopathic thrombocytopenic purpura (ITP) may have no signs and symptoms. When they do occur, they may include:

  • Easy or excessive bruising (purpura)
  • Superficial bleeding into the skin that appears as a rash of pinpoint-sized reddish-purple spots (petechiae), usually on the lower legs
  • Bleeding from the gums or nose
  • Blood in urine or stools
  • Unusually heavy menstrual flow

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

Bleeding that won’t stop is a medical emergency. Seek immediate help if you or your child experiences bleeding that can’t be controlled by the usual first-aid techniques, such as applying pressure to the area.

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes idiopathic thrombocytopenic purpura (ITP)?

In some people thrombocytopenia is caused by the immune system mistakenly attacking and destroying platelets. If the cause of this immune reaction is unknown, the condition is called idiopathic thrombocytopenic purpura. Idiopathic means “of unknown cause.”

In most children with ITP, the disorder follows a viral illness, such as the mumps or the flu. It may be that the infection triggers the immune system malfunction.

Increased breakdown of platelets

In people with ITP, antibodies produced by the immune system attach themselves to the platelets, marking the platelets for destruction. The spleen, which helps your body fight infection, recognizes the antibodies and removes the platelets from your system. The result of this case of mistaken identity is a lower number of circulating platelets than is normal.

A normal platelet count is generally between 150,000 and 450,000 platelets per microliter of circulating blood. People with ITP often have platelet counts below 20,000. Because platelets help the blood clot, as their number decreases, your risk of bleeding increases. The greatest risk is when your platelet count falls very low — below 10,000 platelets per microliter. At this point, internal bleeding may occur even without any injury.

Risk factors

What increases my risk for idiopathic thrombocytopenic purpura (ITP)?

There are many risk factors for idiopathic thrombocytopenic purpura (ITP), such as:

  • Your sex. Women are two to three times more likely to develop ITP than men are.
  • Recent viral infection. Many children with ITP develop the disorder after a viral illness, such as mumps, measles or a respiratory infection.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is idiopathic thrombocytopenic purpura (ITP) diagnosed?

Your doctor will perform a complete physical exam. They’ll ask you about your medical history and the medications you’re taking.

Your doctor will also order a blood test that includes a complete blood count. The blood test may also include a test to determine if your blood contains platelet antibodies.

Your doctor may also perform a blood smear, in which some of your blood is placed on a glass slide and viewed under a microscope to verify the number of platelets seen in the complete blood count.

If you have a low platelet count, your doctor may also order a bone marrow test. If you have ITP, your bone marrow will be normal. This is because your platelets are destroyed in the bloodstream and spleen after they leave the bone marrow. If your bone marrow is abnormal, your low platelet count will likely be caused by another disease, not ITP.

How is idiopathic thrombocytopenic purpura (ITP) treated?

Your doctor will choose your treatment based on the total number of platelets you have and on how often and how much you bleed. In some cases, treatment isn’t needed. For example, children that develop the acute form of ITP usually recover within six months without any treatment.

Adults with less severe cases of ITP may also not require treatment. However, your doctor will still want to monitor your platelet count to make sure you don’t need treatment in the future.

Medications

If you or your child requires treatment, your doctor will likely prescribe medications as the first course of treatment. The most common medications used to treat ITP include:

Corticosteroids

Your doctor may prescribe a corticosteroid, such as prednisone, which can increase your platelet count by decreasing the activity of your immune system.

Intravenous Immune Globulin (IVIG)

If your bleeding has reached a critical level or you are going to have surgery and need to increase your platelet count quickly, you may be given intravenous immune globulin (IVIG).

Thrombopoietin Receptor Agonists

Thrombopoietin receptor agonists, including romiplostim and eltrombopag, help prevent bruising and bleeding by causing your bone marrow to produce more platelets.

If these medications don’t improve your symptoms, your doctor may choose to prescribe other drugs, including:

Immunosuppressants

Immunosuppressants inhibit the activity of the immune system. They include:

  • Rituximab (rituxan)
  • Cyclophosphamide (cytoxan)
  • Azathioprine (Imuran, Azasan)

However, they have significant side effects.

Experimental Drugs

New medications that increase platelet production are being studied in clinical trials. Two of these, eltrombopag and AMG 531, appear to be well-tolerated. However, studies are continuing to determine whether they are safe and effective.

Antibiotics

Some people with ITP are also infected with Helicobacter pylori, which is the same bacteria that causes most peptic ulcers. Antibiotic therapy to eliminate H. pylori has helped increase platelet counts in some people.

Surgery

If you have severe ITP and medication doesn’t improve your symptoms or platelet count, your doctor may advise surgery to remove your spleen. This is called a splenectomy. Your spleen is located in your upper left abdomen.

Splenectomy isn’t usually performed in children because of the high rate of spontaneous remission, or unexpected improvement.

Emergency Treatment

Severe or widespread ITP requires emergency treatment. This usually includes transfusions of concentrated platelets and intravenous administration of a corticosteroid such as methylprednisolone, IVIG, or both.

Treatment for ITP During Pregnancy

Treatment for pregnant women with ITP depends on the platelet count. If you have a mild case of ITP, you probably won’t need any treatment other than careful monitoring and regular blood tests.

If you have an extremely low platelet count or excessive bleeding, you’re more likely to experience serious, heavy bleeding during and after delivery. In these cases, your doctor will work with you to determine a treatment plan that will help maintain a safe platelet count without adversely affecting your baby.

Although most babies born to mothers with ITP aren’t affected by the disorder, some are born with or develop a low platelet count soon after birth. In most cases, the platelet count will return to normal without any treatment. Treatment may be necessary for babies with very low platelet counts.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage idiopathic thrombocytopenic purpura (ITP)?

The following lifestyles and home remedies might help you cope with idiopathic thrombocytopenic purpura (ITP):

  • Avoid certain over-the-counter drugs that can affect platelet function, including aspirin, ibuprofen (Advil, Motrin), and the blood-thinning medication warfarin (Coumadin).
  • Limit your intake of alcohol because consuming too much alcohol can adversely affect blood clotting.
  • Choose low-impact activities instead of competitive sports or other high-impact activities to decrease your risk of injury and bleeding.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: November 17, 2017 | Last Modified: November 17, 2017

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