Idiopathic Thrombocytopenic Purpura

Idiopathic thrombocytopenic purpura (ITP) is a bleeding condition in which the blood doesn’t clot as it should. This is due to a low number of blood cell fragments called platelets. Platelets stick together (clot) to seal small cuts or breaks on blood vessel walls and stop bleeding.

There are two types of ITP:

  • Acute ITP generally lasts less than 6 months. It mainly occurs in children, both boys and girls, and is the most common type of ITP. Acute ITP often occurs after an infection caused by a virus.
  • Chronic ITP is long-lasting and mostly affects adults. However, some teenagers and children can get this type of ITP. Chronic ITP affects women 2 to 3 times more often than men.

ITP is a fairly common blood disorder, with 50 to 150 new cases per every 1 million people each year; about half of these cases are children. However, the number of cases of ITP is rising because routine blood tests that can detect a low platelet count are being done more often. ITP can’t be passed from one person to another.

In most cases, an autoimmune response is believed to cause ITP. Normally your immune system helps your body fight off infections and diseases. But if you have ITP, your immune system attacks and destroys its own platelets. The reason why this happens isn’t known.

Children who get acute ITP often have had recent viral infections. It’s possible that the infection somehow “triggers” or sets off the immune reaction that leads to ITP in these children. ITP in adults, on the other hand, doesn’t seem to be linked to infections.

A low number of platelets doesn’t cause symptoms like pain, fatigue, or problems concentrating, however people who have ITP may have:

  • Purple bruises that appear on the skin or on the mucous membranes. The bruises mean that bleeding has occurred in small blood vessels under the skin.
  • Bleeding that results in tiny red or purple dots on the skin. These pinpoint-sized dots are called petechiae. Petechiae may look like a rash.
  • Nosebleeds, bleeding from the gums when they have dental work done, or other bleeding that’s hard to stop. Women who have ITP may have menstrual bleeding that’s heavier than usual.
  • Blood in the urine or stool (bowel movement).

More extensive bleeding can cause hematomas. A hematoma is a collection of clotted or partially clotted blood under the skin. It looks or feels like a lump.

Bleeding in the brain as a result of ITP is very rare, but can be life threatening if it occurs.

Treatment depends on how severe the bleeding symptoms are and the platelet count. In mild cases, treatment may not be needed.

For most children and adults, ITP isn’t a serious or life-threatening condition. Acute ITP in children often goes away on its own within a few weeks or months and doesn’t return. In 80 percent of children who have ITP, the platelet count returns to normal within 6 to 12 months. Treatment may not be needed.

A small number of children, about 5 percent, whose ITP doesn’t go away on its own may need to have further medical or surgical treatment.

Chronic ITP will vary with each individual and can last for many years. Even people who have severe forms of chronic ITP can live for decades. Most people who have chronic ITP are able at some point to stop treatment and keep a safe platelet count.

Treatments used for children and adults are similar. Medicines often are used as the first course of treatment. They include:

  • Corticosteroids – help increase your platelet count by lowering the activity of your immune system. However, steroids have a number of side effects, and some people relapse (get worse) when treatment ends.
  • Immune globulin and anti-Rh (D) immunoglobulin.

If necessary, the spleen will be removed surgically. The spleen makes antibodies (proteins) that help fight infection. In ITP, these antibodies destroy platelets. If ITP hasn’t responded to steroids, removing the spleen will reduce the destruction of platelets. However, it also may make you more likely to get certain infections.

Some people with ITP who have severe bleeding may need to have platelet transfusions and be hospitalized. Some people will need a platelet transfusion before having surgery. For a platelet transfusion, donor platelets from a blood bank are injected into the recipient’s bloodstream. This increases the platelet count for a short time.

You can’t prevent ITP, but you can prevent its complications:

  • Talk to your doctor about which medicines you can take. Your doctor may advise you to avoid medicines such as aspirin or ibuprofen that can affect your platelets and increase your risk of bleeding.
  • Protect yourself from injuries that can cause bruising or bleeding.
  • Seek treatment right away if you develop any infections. Report any symptoms of infection, such as a fever, to your doctor. This is very important for people with ITP who have had their spleens removed.