Immune thrombocytopenia (ITP)

Immune thrombocytopenia (ITP) is a disorder that can lead to easy or excessive bruising and bleeding. The bleeding results from unusually low levels of platelets — the cells that help blood clot.

Formerly known as idiopathic thrombocytopenic purpura, ITP can cause purple bruises, as well as tiny reddish-purple dots that look like a rash.

Children may develop ITP after a viral infection and usually recover fully without treatment. In adults, the disorder is often long term.

If you don't have signs of bleeding and your platelet count isn't too low, you may not need any treatment. If your symptoms are more severe, treatment may include medications to boost your platelet count or surgery to remove your spleen.

Symptoms

Immune thrombocytopenia may have no signs and symptoms. When they do occur, they may include:

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

When to see a doctor

Make an appointment with your doctor if you or your child develops warning signs that worry you. 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.

Causes

Immune thrombocytopenia usually happens when your immune system mistakenly attacks and destroys platelets, which are cell fragments that help blood clot. In adults, this may be triggered by infection with HIV, hepatitis or H. pylori — the type of bacteria that causes stomach ulcers. In most children with ITP, the disorder follows a viral illness, such as the mumps or the flu.

Risk factors

ITP is more common among young women. The risk appears to be higher in people who also have diseases such as rheumatoid arthritis, lupus and antiphospholipid syndrome.

Complications

A rare complication of immune thrombocytopenia is bleeding into the brain, which can be fatal.

If you're pregnant and your platelet count is very low or you have bleeding, you have a greater risk of heavy bleeding during delivery. Your doctor may suggest treatment to maintain a stable platelet count, taking into account the effects on your baby.

Diagnosis

To diagnose immune thrombocytopenia, your doctor will try to exclude other possible causes of bleeding and a low platelet count, such as an underlying illness or medications you or your child may be taking.

Blood tests can check the levels of platelets. Rarely, adults might need a bone marrow exam to rule out other problems.

Treatment

People with mild immune thrombocytopenia may need nothing more than regular monitoring and platelet checks. Children usually improve without treatment. Most adults with ITP will eventually need treatment, as the condition often becomes severe or long term (chronic).

Treatment may include a number of approaches, such as medications to boost your platelet count or surgery to remove your spleen (splenectomy). Talk with your doctor about the risks and benefits of your treatment options. Some people find that the side effects of treatment are more burdensome than the effects of the disease itself.

Medications

Your doctor will talk with you about over-the-counter medications or supplements you take and whether you need to stop using any that might inhibit platelet function. Examples include aspirin, ibuprofen (Advil, Motrin IB, others) and ginkgo biloba.

Medications to treat ITP may include:

• Steroids. Your doctor will likely start you on an oral corticosteroid, such as prednisone. Once your platelet count is back to a safe level, you can gradually discontinue taking the drug under the direction of your doctor. Long-term use of these medications isn't recommended because they can increase your risk of infections, high blood sugar and osteoporosis.
• Immune globulin. If corticosteroids don't help, your doctor may give you an injection of immune globulin. This drug may also be used if you have critical bleeding or need to quickly increase your blood count before surgery. The effect usually wears off in a couple of weeks.
• Drugs that boost platelet production. Medications such as romiplostim (Nplate) and eltrombopag (Promacta) help your bone marrow produce more platelets. These types of drugs can increase your risk of blood clots.
• Other drugs. Rituximab (Rituxan, Truxima) helps increase your platelet count by reducing the immune system response that's damaging your platelets. But this drug also can reduce the effectiveness of vaccinations, which may be needed if you later choose surgery to remove your spleen.

Surgery

If your condition is severe or persists despite initial drug treatment, your doctor may suggest surgery to remove your spleen. This quickly eliminates the main source of platelet destruction in your body and improves your platelet count, though it doesn't work for everyone. Living without a spleen permanently increases your susceptibility to infection.

Emergency treatment

Although rare, severe bleeding can occur with ITP. Emergency care usually includes transfusions of platelet concentrates. Steroids and immune globulin may also be given through a tube in a vein.

Lifestyle and home remedies

If you have immune thrombocytopenia, try to:

• Avoid contact sports. Depending on your risk of bleeding, head impacts during sports like boxing, martial arts and football could cause bleeding in your brain. Talk to your doctor about what activities are safe for you.
• Watch for signs of infection. If you've had your spleen removed, be alert for any signs of infection, including fever, and seek prompt treatment. Infections can be more serious in people without spleens.
• Use caution with over-the-counter medications. Nonprescription drugs such as aspirin and ibuprofen (Advil, Motrin IB, others) can impair platelet function.

Preparing for an appointment

Because a low platelet count may not cause symptoms, the problem is often discovered when you have a blood test for another reason. To diagnose immune thrombocytopenia, your doctor is likely to order further blood tests that require drawing a small amount of blood from a vein in an arm. He or she may also refer you to a specialist in blood diseases (hematologist).

What you can do

Here are some steps you can take to get ready for your appointment:

• List any symptoms you're experiencing, including those that seem unrelated to the reason for which you scheduled the appointment.
• List key personal information, including major stresses, life changes, and recent illnesses or medical procedures, such as a blood transfusion.
• List all medications, vitamins and supplements that you're taking, including doses.
• Ask a family member or friend to come with you. In addition to offering support, he or she can write down information from your doctor or other clinic staff during the appointment.
• List questions to ask your doctor. Preparing a list of questions can help you make the most of your time together.

Questions about ITP may include:

• How many platelets do I have in my blood?
• Is my platelet count dangerously low?
• What is causing my ITP?
• Do I need more tests?
• Is this condition temporary or long lasting?
• What treatments are available, and what do you recommend?
• What will happen if I do nothing?
• What are the possible side effects of the treatments you're suggesting?
• Are there any restrictions that I need to follow?
• Is there a generic alternative to the medicine you're prescribing?
• Do you have any brochures or other printed material that I can take with me? What websites do you recommend?

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