Idiopathic Thrombocytopenic Purpura
(Idiopathic Thrombocytopenic Purpura; ITP)
Immune thrombocytopenia purpura (ITP) is a bleeding disorder. It is a reduction in the number of platelets in your blood. Platelets are small cells in your blood that stick together to form blood clots. These clots help stop bleeding at injury sites. Low platelet levels with ITP makes it easier to develop bruises or bleed even with minor injuries.
There are 2 types of ITP:
- Lasts less than 6 months
- Usually occurs in children
- Most common type of ITP
- Lasts longer than 6 months
- Usually occurs in adults
ITP is caused by a problem with the immune system. The immune system places a tag on platelet cells. This tag mistakenly identifies platelets as foreign material. Organs like the spleen and liver will then remove the tagged platelets as they pass through in the blood. Gradually, this process will reduce the number of platelets in your blood. Eventually, the decreased levels of platelets will be severe enough to interfere with the blood's ability to clot.
For most ITP, it is not clear what causes the problem with immune system. In children, ITP is often associated with a recent infection with a virus. ITP in adults has not been linked to viruses.
Some cases of ITP are thought to be caused by drugs or other immune disorders.
Women, especially those younger than 40 years of age, are more likely to get ITP than men. Children with a recent viral infection or live virus vaccination are also at increased risk.
Both adults and children may notice the following symptoms:
- Easy bruising
- Blood in urine or stools
- Bleeding for longer than normal following an injury
- Unexplained nosebleeds
- Bleeding from the gums
- In adult women, heavier-than-normal menstrual periods
- Red dots—may occur in groups and resemble a rash
- Bleeding within the intestinal tract or brain—rare
You will be asked about your symptoms and medical history. A physical exam will be done.
Your bodily fluids will be tested. This can be done with:
- Blood tests
- Bone marrow tests
Treatment for ITP is different for children and adults. ITP is short term in most children. Most children will recover without any treatment. Adults are more likely to develop a chronic form of ITP. Not all of these chronic ITPs will require treatment. Talk with your doctor about the best plan for you.
Some treatment options include:
Medication may help to either slow the destruction of platelet cells or increase production of platelets. The overall goal is to maintain a healthy level of platelets in the blood.
To increase platelet counts in the blood, your doctor may advise:
- Steroids to lower the activity of the immune system and decrease the destruction of platelets
- Gamma globulin infusions to slow down platelet destruction; it usually works more quickly than steroids
Both of these treatments work, but both can have side effects.
Medication may also be given to stimulate platelet production. These medications may prevent the need for surgery.
A platelet transfusion may be used to prevent the platelet count from dropping too low.
A splenectomy may be done if medication is not effective.
A splenectomy is the removal of the spleen. The spleen is the main site of platelet destruction. Without your spleen, your platelet levels should begin to improve. However, the missing spleen also makes you more likely to get certain infections. This surgery is usually not done until all medication options have been tried.
Since the cause of ITP is unknown, there are no specific ways of preventing it. However, bleeding and injury can be serious for people with ITP. To decrease the chance of bleeding injuries:
- Take precautions in your child's environment. Consider padding an infant's crib or play area.
- Make sure that older children wear helmets and protective gear when playing sports. This will help to reduce bruising injuries.
- Consider temporarily stopping contact sports such as football and rough game playing when platelet counts are low.
- Avoid medications that contain aspirin or ibuprofen. These medications can reduce platelet activity.
Family Doctor—American Academy of Family Physicians
National Heart, Lung, and Blood Institute
Canadian Medical Association Journal
Bussel JB; Cheng G; et al. Eltrombopag for the treatment of chronic idiopathic thrombocytopenic purpura. N Engl J Med. 2007 Nov 29;357(22):2237-2247.
Immune thrombocytopenia (ITP) in adults. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114263/Immune-thrombocytopenia-ITP-in-adults. Updated June 29, 2016. Accessed September 26, 2016.
George JN, Woolf SH, et al. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for The American Society of Hematology. Available at: http://www.ouhsc.edu/platelets/itp/ITP%20Publications/pub2_1.pdf. Accessed June 13, 2016.
Karpatkin S. Autoimmune (idiopathic) thrombocytopenic purpura. Lancet. 1997;349:1531-1536.
Newland A, Caulier MT, et al. An open-label, unit dose-finding study of AMG 531, a novel thrombopoiesis-stimulating peptibody, in patients with immune thrombocytopenic purpura. Br J Haematol. 2006 Nov;135(4):547-553.
What is immune thrombocytopenia? National Heart Lung and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/itp/. Updated March 14, 2012. Accessed June 13, 2016.
Last reviewed June 2016 by Michael J. Fucci, DO
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.